Cholestatic hepatitis as a clinical mask of choledocholithiasis

The variety of cholelithiasis clinical manifestations, seriously impeding the timely diagnosis, are well known. This is determined by multiple impairment of interorgan communication in cholelithiasis. The most difficult form of cholelithiasis both for identification, and for treatment is choledocholithiasis. Diagnosis of stones in the common bile duct is based on a complex of clinical, laboratory and instrumental data. The appearance of jaundice amid the abdominal pain and revealing signs of biliary hypertension during instrumental examination are considered typical for choledocholithiasis. Particular difficulties for the diagnosis are choledocholithiasis cases with atypical pain syndrome, the absence of jaundice and non-dilated bile ducts. One of the reasons for the variability of pain syndrome in cholelithiasis is polymorbidity of these patients. Relatively frequently, bile duct stones are combined with a hiatal hernia, which is pathogenetically interdependent. Clinical manifestations in such cases depends on what syndrome is the dominant. Non-dilated bile ducts in patients with proven choledocholithiasis was detected in 5.8% of patients. In this situation, the presence of cholestasis and cytolysis biochemical markers in the absence of instrumental signs of biliary hypertension can simulate intrahepatic cholestasis. Clinical case demonstrating the difficulty of choledocholithiasis diagnosis is presented. In a given clinical observation the patient with a history of cholecystectomy for cholelithiasis; with intense abdominal pain, primarily appraised as a manifestation fixed hiatal hernia; pronounced anicteric cholestatic syndrome, was presented. No signs of biliary hypertension in the standard transabdominal ultrasound examination of the abdomen required exclusion of intrahepatic causes of cholestasis. In-depth instrumental and laboratory examination allowed to diagnose in patient choledocholithiasis. It is proposed to mark out variant of the cholelithiasis course with the stones localization in the common bile duct under the guise of cholestatic hepatitis.

cholelithiasis, choledocholithiasis, cholestatic hepatitis