A Case of Primary Intrahepatic Pure Cholesterol Stone Accompanied with Black Stone in the Gallbladder

Shingo Inoue, Kazuyoshi Kunitomo, Tetsuya Suzuki, Kazuo Miura, Jun Itakura, Yoshirou Matsumoto

First Department of Surgery, Yamanashi Medical College

Cholecystolithiasis and hepatolithiasis were detected by abdominal ultrasonography in a 50-year-old man who complained of right hypochondralgia. Spindle-like dilatation of the bile duct without stenosis was visualized in the lateral segment of the liver by endoscopic retrograde cholangiopancreaticography. Cholecystectomy and lateral segmentectomy were performed. In the gallbladder, there were small black stones that were amorphous in section. No atrophy was seen in the resected liver and black muddy stones filled the dilated intrahepatic bile duct. Because the slight thickness of the dilated bile duct was seen only histopathologically, this appearance did not indicate chronic proliferative cholangitis. Chemical analysis of these stones revealed that the gallbladder stones were composed of calcium carbonate, calcium bilirubinate and calcium phosphate, and the intrahepatic stones were composed of pure cholesterol. The pathogenesis of both the stones were obscure. This is a very rare case and we could not find an identical case in the world literature.

Key words
intrahepatic pure cholesterol stone, black stone in the gallbladder

Reprint requests
Shingo Inoue First Department of Surgery, Yamanashi Medical College
1110 Shimokato, Tamaho-cho, Nakakoma-gun, Yamanashi, 409-38 JAPAN

Accepted
December 10, 1991

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