Giant Lt Intrahepatic Stone Causing Severe Cholangiohepatitis, treated Surgically: Case Report

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Background: Recurrent pyogenic cholangitis (RPC) is a chronic hepatobiliary disease characterized by the formation of intrahepatic biliary stones, leading to inflammatory strictures and progressive obstruction of the biliary tree.This pathogenesis can result in recurrent episodes of cholangitis.Although it more commonly observed in east and southeast Asia, it remains rare in Gulf region.The disease exhibits a spectrum of clinical manifestations ranging from asymptomatic to mild and severe presentation to potentially life-threatening conditions.Aim: We report the case of a giant intrahepatic stone causing RPC to highlight the importance of multidisciplinary approach in such complicated illness despite the paucity of its presentation in Arab countries.Available therapeutic options include non-surgical endoscopic approaches and surgical from drainage up to hepatectomy and biliary reconstructions. Methods & Result:We describe the case of a 45-year-old male patient who presented with a picture of obstructive jaundice associated with fever and raised liver enzymes.MRCP demonstrated a 5.5 cm left intrahepatic stone with dilated biliary radicals.ERCP succeeded to drain the common bile duct however failed to clear left hepatic duct and intrahepatic biliary system.Patient underwent left hepatectomy with uneventful outcome.Conclusion: Hepatolithiais is an uncommon liver pathology in non-Asian areas.It can cause serious complications and consequent cholangiocharcinoma.Management primarily focuses on complete stone removal and correction of associated biliary stricture.However, in selected cases hepatectomy may be warranted as a definitive therapeutic option.

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