Clinical

Mild transient liver injury seen with cholecystitis/cholelithiasis minus stones

Last Updated: 2009-09-09 17:34:01 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Cholecystitis and cholelithiasis can produce a transient mild hepatocellular injury even with no common bile duct (CBD) stones, researchers from Taiwan report.

Hepatocellular injury in patients with cholecystitis is usually attributed to CBD stones, Dr. Shou-Chuan Shih and colleagues from Mackay Memorial Hospital, Taipei, point out in the August 14 issue of the World Journal of Gastroenterology.

To see whether liver injury occurs in the absence of CBD stones, Dr. Shih's group reviewed the medical records of 186 patients with cholelithiasis and cholecystitis who underwent cholecystectomy and had imaging studies to detect CBD stones.

Of 96 patients without stones in the CBD, 49 (51%) had elevated alanine aminotransferase levels (highest, 566 IU/dL), "averaging 2 to 3 times the normal upper limit," Dr. Shih noted in an email correspondence to Reuters Health.

Forty of the 96 patients (42%) had elevated aspartate aminotransferase levels. Total bilirubin and alkaline phosphatase were mildly elevated in 27% and 23% of these patients, respectively.

As expected, manifestations of hepatocellular injury were seen -- and were even more pronounced -- in the 90 patients with CBD stones.

"These markers of hepatocellular injury resolved almost completely within 2 weeks to 1 month after cholecystectomy," Dr. Shih reported.

"This hepatocellular injury appeared to be a transient, reactive phenomenon secondary to cholecystitis associated with cholelithiasis, whether or not there had been stones in the CBD," the investigators note in their report.

This kind of liver injury, they add, "should not be an obstacle to preparation of these patients for surgical intervention. Its activity is transient and mild (and) needs no further management and will resolve spontaneously as expected, assuming the diseased gallbladder is removed."

World J Gastroenterol 2009;15:3788-3792.