Hepatolithiasis, a clinical study.

Ninety-seven hepatolithiasis cases were reviewed retrospectively. Primary hepatolithiasis was about equal in both sexes, with most patients under 39 years of age. Most secondary hepatolithiasis patients who were female-predominant, were older than 40. Common presenting symptoms were abdominal pain, either epigastric or right upper quadrant of abdomen as noted in 93%; chills and fever in 70%; nausea and vomiting in 49.5%; jaundice was noted only in 39% of the patients. Blood tests showed elevation of alkaline phosphatase in 79.8%, and gamma-GT in 88.3%. Left branch involvement was much more common that right. Escherichia coli (E. coli) was the main organism isolated in most of the cases. Abdominal ultrasonography reached a diagnostic rate of 91.01%, and the condition could be missed in cases of intrahepatic muddy stones, pneumobilia and misidentification of the location of the stones. Endoscopic retrograde cholangiography (ERC) showed a clearer picture of the biliary tree, but failed in cases of distorted anatomy because of previous operation, stones impacted in the ampulla orifice, presence of diverticulum or poor opacification of the bile duct because of stricture or stone impaction.