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Biliary stones proximal to the confluence of the left and/or right hepatic duct are referred to as intrahepatic stones or hepatolithiasis. Intrahepatic stones may remain asymptomatic for a long time. Symptoms occur in association with stone growth and migration or infection. The most common symptoms are abdominal pain, colics, jaundice, and fever. Risk factors are cholestasis, infections, and anatomic abnormalities. For diagnosis, transabdominal ultrasound is the first approach; if not detectable, magnetic resonance cholangiopancreatography (MRCP) should be performed. The prognosis is determined by acute and chronic complications such as ascending infections, secondary biliary cirrhosis, segmental or lobar atrophy, liver abscess, and cholangiocarcinoma. Endoscopic treatments involve endoscopic retrograde cholangiopancreatography (ERCP), percutaneous transhepatic lithotripsy, and cholangioscopy. The surgical treatment includes hepatic resection, reconstruction of bile duct stricture, and liver transplantation. Diagnostic and therapeutic algorithms are discussed in this chapter.
KeywordsHepatolithiasis ERCP Cholangioscopy Lithotripsy Surgical treatment MRCP Ascending infections Secondary biliary cirrhosis Liver abscess Lobular atrophy
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