Abstract
A 21-year-old woman admitted to our hospital with a diagnosis of hepatolithiasis 9 months after surgery for congenital biliary dilatation. The operative procedures she had recieved, were resection of gallbladder and extrahepatic bile duct followed by hepaticojejunostomy. At the previous surgery no stones had been found in the intrahepatic bile ducts.
Several examinations revealed the stones in bilateral residual intrahepatic bile ducts. The stones were removed completely with percutaneous transhepatic cholangioscopic lithotomy (PTCL). There were two fibrous sticks passing through the stones like axis. It was thought that its origin was food. No stenosis was noted at the hepaticojejunostorny, but it was slightly narrower than that of residual intrahepatic bile duct. Stagnation of bile and reflux of intestinal contents was considered to be the cause of hepatolithiasis.
During the treatment, we also found a few mucosal bridge like lesions in the bilateral intrahepatic bile duct. This finding is very rare, and we found only one case report about this lesion in the literatures. Referring the literature, this mucosal bridge contains an artery. In our case, it was suspected with the intraductal ultrasonography that this lesion also contains somethiing in it. It is suggested that careless endoscopic resection of this mucosal bridge is risky.
