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World J Gastroenterol. Aug 14, 2009; 15(30): 3788-3792
Published online Aug 14, 2009. doi: 10.3748/wjg.15.3788
Acute transient hepatocellular injury in cholelithiasis and cholecystitis without evidence of choledocholithiasis
Chen-Wang Chang, Wen-Hsiung Chang, Ching-Chung Lin, Cheng-Hsin Chu, Tsang-En Wang, Shou-Chuan Shih
Chen-Wang Chang, Wen-Hsiung Chang, Ching-Chung Lin, Cheng-Hsin Chu, Tsang-En Wang, Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Mackay Medicine, Nursing and Management College, Taipei 10449, Taiwan, China
Shou-Chuan Shih, Division of Gastroenterology, Department of Internal Medicine, Health Evaluation Center, Mackay Memorial Hospital, Mackay Medicine, Nursing and Management College, Taipei 10449, Taiwan, China
Author contributions: Chang CW and Shih SC contributed to the study design, data collection and manuscript correction and editing; Chang WH, Lin CC and Wang TE analyzed and interpreted the data; Chu CH approved the final version of the paper.
Correspondence to: Shou-Chuan Shih, MD, Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Sec. 2, Chung-Shan N. Road, Taipei 10449, Taiwan, China. mmhgiman@gmail.com
Telephone: +886-2-25433535
Fax: +886-2-25433642
Received: May 18, 2009
Revised: July 8, 2009
Accepted: July 15, 2009
Published online: August 14, 2009
Abstract

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 (1.14 ± 1.27 mg/dL vs 2.66 ± 1.97 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.

Keywords: Acute transient hepatitis; Cholelithiasis; Cholecystitis; Hyperbilirubinemia; Leukocytosis