Acute transient hepatocellular injury in cholelithiasis and cholecystitis without evidence of choledocholithiasis

• Published in: World journal of gastroenterology : WJG Vol. 15; no. 30; pp. 3788 - 3792
• Main Authors: Chang, Chen-Wang, Chang, Wen-Hsiung, Lin, Ching-Chung, Chu, Cheng-Hsin, Wang, Tsang-En, Shih, Shou-Chuan
• Format: Journal Article
• Language: English
• Published: United States Division of Gastroenterology,Department of Internal Medicine,Mackay Memorial Hospital,Mackay Medicine,Nursing and Management College,Taipei 10449,Taiwan,China%Division of Gastroenterology,Department of Internal Medicine,Health Evaluation Center,Mackay Memorial Hospital,Mackay Medicine,Nursing and Management College,Taipei 10449,Taiwan,China 14.08.2009; The WJG Press and Baishideng
• Subjects: Adult; Aged; Aged, 80 and over; Brief; Cholecystectomy; Cholecystitis - pathology; Cholecystitis - physiopathology; Cholecystitis - surgery; Choledocholithiasis - pathology; Choledocholithiasis - physiopathology; Cholelithiasis - pathology; Cholelithiasis - physiopathology; Cholelithiasis - surgery; Female; Humans; Liver - pathology; Liver Diseases - pathology; Liver Diseases - physiopathology; Male; Middle Aged; Retrospective Studies; 急性肝损伤; 胆囊炎; 胆总管结石; Acute transient hepatitis; Hyperbilirubinemia; Leukocytosis; Cholelithiasis; Cholecystitis
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.15.3788

AIM： To investigate acute transient hepatocellular injury in patients with cholelithiasis and cholecystitis but no evidence of choledocholithiasis. METHODS： The medical records of patients with cholelithiasis who underwent cholecystectomy between July 2003 and June 2007 were retrospectively reviewed. Imaging studies to detect common bile duct （CBD） stones were performed in 186 patients, who constituted the study population. Biochemical liver tests before and after surgery, and with the presence or absence of CBD stones were analyzed. RESULTS： In 96 patients with cholelithiasis and cholecystitis without evidence of CBD stones, 49 （51.0%） had an alanine aminotransferase level elevated to 2-3 times the upper limit of normal, and 40 （41.2%） had an elevated aspartate aminotransferase level. Similar manifestations of hepatocellular injury were, as would be expected, even more obvious in the 90 patients with CBD stones. These markers of hepatocellular injury resolved almost completely within 2 wk to 1 mo after cholecystectomy. Compared to 59 patients with histologically less severe cholecystitis in the group undergoing urgent surgery （total 74 patients）, the 15 patients with a gangrenous gallbladder had a higher mean level of total bilirubin （2.14 ± 1.27 mg/dL vs 2.66 ± 2.97 mg/dL, P 〈 0.001） and white cell count （9480 ± 4681/μL vs 12840 ± 5273/μL, P = 0.018）.CONCLUSION： Acute hepatocellular injury in cholelithiasis and cholecystitis without choledocholithiasis is mild and transient. Hyperbilirubinemia and leukocytosis may predict severe inflammatory changes in the gallbladder.