[Intrahepatic lithiasis (considerations on 20 cases)].

The authors present an analysis of 20 cases with intrahepatic lithiasis, stressing the possibility of the development of lithiasis inside the liver as a result of either metabolic disturbances (one case), or secondary to congenital obstacles (2 cases), or following surgery (3 cases). In the remaining 12 cases intrahepatic lithiasis was secondary to lithiasis in the hepato-choledocus canal through a mechanism of ascending obstruction - identified in 5 cases -,or it was due to ascending migration of calculi (in 7 cases). The diagnosis is made with the aid of good quality intra-surgery cholangiographia. There are various possibilities for surgical solution, but the authors have preferred the bilio-digestive anastomosis that was performed in 15 of the patients. The hepatic duct-jejunal anastomosis on a "Y" loop is considered to be the method that responds most satisfactorily to operatory objectives. Various conditions are discussed, that may render the solution of the condition more difficult from the surgical viewpoint, such as the presence of congenital intrahepatic septa, or the development of intrahepatic lithiasis in a patient with a narrow hepato-choledocus duct. The mortality rate was of 20% (4 patients). Death occurred through acute hepator-renal failure.