Report concerning the youngest known patient with primary intrahepatic pure cholesterol stones

Abstract

A 19-year-old student was admitted because of right upper abdominal pain. Ultrasonography showed highly echogenic masses accompanied by acoustic shadows in the periphery of the anterior and posterior branches of the right intrahepatic bile duct. ERCP and PTC revealed radiopaque images in the periphery of B₅ and B₇7, but there were no radiopaque objects in the gallbladder or the common bile duct. The posterior segment branch was confluent to the extrahepatic bile duct, and the cystic duct showed anomalous fusion at the root of the posterior branch. One branch in B₅ filled with many small stones had a filamentous and angular portion at its Junction. Right anteroinferior (B₅) and posterior (B₆,₇) subsegmentectomy was performed. No stones were found in the gallbladder on the common bile duct. The calculi were determined to be “pure cholesterol stones” with over 90% cholesterol content by the KBr-tablet method, but a radiating crystalline pattern in the cut surface was not detected. Primary intrahepatic pure cholesterol stones are rate, and only seven cases under 30 years of age have been reported. Our patient was younger than those previously described in the literature.