A Case of Intrahepatic Pure Cholesterol Stones Localized in the Caudate Lobe

Hiroyuki Hamba, Osamu Yamazaki, Kwang Choon Lee, Hiroaki Kinoshita*, Kazuhiro Hirohashi*

Department of Surgery, Osaka City Momoyama Municipal Hospital
*Second Department of Surgery, Osaka City University Medical School

A case of common bile duct (CBD) stone and intrahepatic, pure cholesterol stones localized in the caudate lobe of the liver with coexisting early gastric cancer is reported. A 65-year-old man had undergone percutaneous transhepatic drainage for liver abscess and cholecystectomy. The early gastric cancer and CBD stone were diagnosed before the operation, but the intrahepatic stone was diagnosed during the operation. Subsequently, the patient underwent subtotal gastrectomy, choledochotomy with T-tube drainage, and resection of the Spiegel lobe of the liver. It is difficult to screen the caudate lobe and detect pure cholesterol stones in the liver by ultrasonography (US) and computed tomography (CT). In our case, examinations of the biliary tract using US, CT, and drip infusion cholangiography (DIC) detected stones in the CBD but not in the liver before the operation. Both intraoperative cholangiography and intraoperative US revealed the stones in the liver. Intraoperative US is especially useful for screening the caudate lobe, because it can scan from any direction of the liver and can be used anytime during the operation.

Key words
hepatolithiasis, primary intrahepatic pure cholesterol stones, caudate lobe

Reprint requests
Hiroyuki Hamba Second Department of Surgery, Osaka City University Medical School
1-5-7 Asahi-machi, Abeno-ku Osaka, 545 JAPAN

Accepted
May 11, 1994

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