Fig 1 - available via license: Creative Commons Attribution 4.0 International
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-Abdominal ultrasound. Abdominal ultrasound revealing (A) thickened gallbladder with cholelithiasis, (B) intrahepatic biliary ductal dilation, and (C) extrahepatic biliary ductal dilation.
Source publication
The patient is a 54-year-old female who presented to the emergency department for episodic right biliary colic with nausea and vomiting over the past year. The patient's symptoms warranted multiple emergency department visits, but were self-limiting. During the most recent visit, the patient had a low-grade fever of 99.8°F (96.8°F-99.5°F) and a bor...
Context in source publication
Context 1
... the emergency department, the patient had a low-grade fever of 99.8 °F (96.8 °F-99.5 °F) and a borderline elevated total bilirubin of 1.2 (0.2-1.2 mg/dL). Ultrasound of the abdomen revealed a distended, thickened gallbladder, cholelithiasis, and intrahepatic and extrahepatic biliary ductal dilatation ( Fig. 1 ). ...
Similar publications
Mirizzi syndrome is a complication of gallstone disease caused by an impacted gallstone in the infundibulum of the gallbladder or within the cystic duct, causing chronic inflammation and extrinsic compression of the common hepatic duct or common bile duct. Eventually, mucosal ulceration occurs and progresses to cholecystobiliary fistulation. Numero...
Mirizzi syndrome (MS) is a rare complication of chronic cholelithiasis. The syndrome describes gallstone obstruction of Hartmann's pouch or the cystic duct that extrinsically compresses the common hepatic duct, causing obstructive jaundice. In advanced cases, the gallstones may erode into the biliary tree creating a fistula, requiring prompt diagno...
Citations
... A diagnostic approach based on two imaging modalities facilitates effective evaluation and management, contributing to a deeper understanding of Mirizzi syndrome's intricate manifestations [10]. ...
Introduction and importance
Mirizzi syndrome, a rare complication of cholelithiasis, involves gallstones causing common hepatic duct compression. It poses diagnostic challenges with nonspecific symptoms. Early recognition and surgical intervention are crucial, emphasizing a multidisciplinary approach for this complex condition with potential complications.
Case report
A 69-year-old woman presented with pruritus, jaundice, and a history of hepatic colics. Laboratory results showed no signs of inflammation but indicated cholestasis. Imaging suggested Mirizzi syndrome type 1, confirmed by MRI. The patient underwent surgery, revealing Mirizzi syndrome type II with the presence of a cholecystocholedochal fistula involving less than one-third of the circumference of the main bile duct. Subtotal cholecystectomy and suturing of the main bile duct onto a T-tube were performed, resulting in a favorable recovery and normalization of blood tests after 10 days.
Clinical discussion
Mirizzi syndrome, named after surgeon Pablo Luis Mirizzi, was first detailed in 1948. Clinical symptoms include jaundice, colic pain, and complications such as cholecystocholedochal fistula and gallstone ileus. Blood tests and imaging aid diagnosis. Surgical management targets obstruction relief and defect repair. Dissecting Calot's triangle carries risks. In complex cases, cholecysto-choledocus-duodenostomy may be considered.
Conclusion
Mirizzi syndrome, a rare but significant condition, demands careful clinical attention to prevent underdiagnosis. Timely and appropriate management, utilizing imaging tests alongside ERCP, is essential for optimal outcomes and complication prevention.
