Successful Treatment of Recurrent Multiple Hepatolithiasis after Choledochectomy and Hepaticojejunostomy for Congenital Bile Duct Dilatation: Left Hepatectomy and Jejunostomy for Endoscopic Lithotomy

Abstract

We treated a 49-year-old man who had undergone choledochectomy and hepaticojejunostomy for congenital bile duct dilatation at the age of 20 years and had been suffering from repeated cholangitis due to hepatolithiasis since he was aged 37 years. Preoperative diagnostic imaging showed multiple bilobar hepatolithiasis, with the largest stone being 35 mm in diameter, and atrophy of the left lobe of the liver. The patient underwent left hepatectomy and jejunostomy to allow endoscopic lithotomy of residual stones in the right lobe, which succeeded in clearing all the intrahepatic bile ducts. Cholangitis caused by hepatolithiasis recurred 19 months after treatment. However, the jejunostomy enabled endoscopic lithotomy to be performed again promptly. This surgical procedure is a useful strategy for recurrence of multiple hepatolithiasis after choledochojejunostomy, which has been reported to be frequent, as it allows repeated and minimally invasive performance of endoscopic lithotomy.