Surgical management of hepatolithiasis: an institutional experience of a rare disease

Hepatolithiasis remains as a rare condition in the majority of western world countries. Although genetic, dietary and environmental factors have been associated with the disease, the exact etiology of this entity remains elusive. Several approaches; surgical and non-invasive have been well described. However, surgery remains the standard of care for definitive treatment of the disease. We sought to present the recent experience of our clinic regarding the surgical management of hepatolithiasis in the backgound of a narrative literature review. All adult patients with hepatolithiasis admitted to our center during the period 2018 to 2020 were included in the study. Patients’ demographics, comorbidities and preoperative characteristics were collected by chart review. All patients underwent open left lateral hepatectomy. Three cases with hepatolithiasis were identified. All of them were male and had been suffering from recurrent pyogenic cholangitis. All patients remained asymptomatic and disease-free through the entire follow-up, except one case that was complicated with bile leakage during the immediate postoperative period. Hepatolithiasis is currently a rare condition in the western world. Surgery is safe and effective treatment approach for refractory cases and, provided that it is performed by experts in hepatobiliary surgery, it remains imperative for the definitive treatment of the disease.

Oriental Cholangiohepatitis in a Caucasian male

Recurrent pyogenic cholangitis (RPC) is a condition found almost exclusively in individuals who lived in Southeast Asia. We report a case of a Caucasian veteran diagnosed with RPC after presenting with a 5-year history of recurrent fevers and abdominal pain 20 years after serving in Japan, South Korea, and Guam. Extensive evaluation led to the diagnosis of RPC with improvement after biliary decompression and antibiotics. Although rare, RPC should be considered in individuals who present with recurrent bouts of abdominal pain and fevers regardless of race.

Repair of Preduodenal Portal Vein Injury with Polytetrafluoroethylene Graft with Midgut Rotation and Left Sided Inferior Vena Cava

Preduodenal Portal Vein (PDPV) is a rare congenital anomaly. The presence of PDPV carries the risk of injury to Portal Vein (PV) during operations involving biliary duct, duodenum and pancreas. This report is about a 50-year-old female patient with PDPV associated with midgut malrotation and left sided Inferior Vena Cava (IVC). The patient was operated for Recurrent Pyogenic Cholangitis (RPC) and associated biliary stones. The patient sustained iatrogenic injury to PV during surgery which was subsequently repaired with Polytetrafluoroethylene (PTFE) graft doppler showed patent graft at three months of follow-up. This report highlights the fact that pre-existing inflammatory conditions of bile duct and hepatoduodenal ligament further increase the risk of injury to PDPV during surgery.