To assess the natural history of cholelithiasis in patients with cirrhosis, 32 charts coded for both diseases were retrospectively reviewed. Cholecystectomy was performed in 22 patients. Only two patients met criteria for acute cholecystitis and two patients had suspected choledocholithiasis. Despite the high incidence of preoperative jaundice (32%), no common duct stones were documented. There was no operative mortality. The complication rate was 45%. In 10 patients not operated upon, two patients died of liver failure and the remaining eight patients are alive 8 months to 13 years after diagnosis (mean: 46 months) with no active biliary disease. It is concluded that: (1) jaundice in this subpopulation most often reflects hepatocellular injury and rarely biliary tract obstruction, (2) there appears to be a much lower incidence of acute cholecystitis and choledocholithiasis in cirrhotic patients with cholelithiasis than in the normal population, and (3) patients with cirrhosis and asymptomatic cholelithiasis can be safely managed without operation.
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