Recurrent pyogenic cholangitis is associated with hepatolithiasis, and is character­ized by intra and extrahepatic biliary stricture s, the formation of stones, and repeated biliary infections. It is predominantly a disease of the Far East, although there have been several North American series reported. Primary hepatolithiasis refers to stones that are formed de novo in the intrahepatic ducts, and secondary hepatolithia­sis results from retrograde migration of stones from the common bile duct and gall­bladder into the intrahepatic ducts due to distal obstruction [ 3 ]. Chronic proliferative cholangitis, which consists of extensive proliferation of fi brous connective tissue, moderate-to-severe infi ltration by infl ammatory cells, and the proliferation of mucus-producing peribiliary glands in the ductal was has been suggested as a fun­damental histologic lesion of stone-bearing intrahepatic bile ducts [ 4 ]. Patients with either primary or secondary hepatolithiasis have recurrent cholangitis, with recur­rent episodes of abdominal pain , fever and or jaundice . Primary treatments include hepatic resection of the disease liver segment, with or without bilioenteric bypass , percutaneous transhepatic cholangioscopic lithotomy (PTCSL), or peroral cholan­gioscopic lithotripsy [ 5 , 6 ]. These procedures can be combined at the time of initial treatment, or utilized in sequence for the frequent recurrence of stones in the biliary tract common in these patients. Even after seemingly effective treatment, patients often suffer from long term complications of recurrent cholangitis, hepatic cirrhosis and cholangiocarcinoma .