[Three-dimensional morphology of intrahepatic bile ducts in patients with intrahepatic gallstones].

Eight livers surgically resected for intrahepatic gallstones were submitted to graphic reconstruction from serial histological sections to correlate the peculiar ductal changes with the pathogenetic aspects of this disease. Reconstruction was aided by a microcomputer system we have developed. Further, morphometric analysis was added to relate the obstruction of portal veins with parenchymal atrophy. Three-dimensionally, the ducts in these livers were strikingly transformed into a chain of ampullar dilatations interposed by either bending or strictures. Morphometrically, even a stenotic segment was wider than a corresponding normal one, showing that it was a relative stricture. The parenchymal lobule was atrophic or even completely destroyed due to the frequent thrombotic obstruction of portal veins about 0.5mm diameter. These 3-D morphology of intrahepatic bile ducts provided little evidence of congenital bile duct anomaly for the origin of intrahepatic gallstones. The basic ductal changes were dilations, alternated with "stenoses" that were more apparent than real. On the other hand, both the frequent obstruction of small portal veins and the lobular atrophy reflected a severely reduced portal blood flow. Not only the recurrent cholangitis that is apt to occur upon dilated ducts, but this functional incompetence of a stone-harboring, atrophic liver lobe strongly suggests a surgical indication for hepatic resection.