Case Report
Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 14, 2006; 12(34): 5579-5581
Published online Sep 14, 2006. doi: 10.3748/wjg.v12.i34.5579
An alternative surgical approach to a difficult case of Mirizzi syndrome: A case report and review of the literature
Michael Safioleas, Michael Stamatakos, Constantinos Revenas, Constantinos Chatziconstantinou, Constantinos Safioleas, Alkiviades Kostakis
Michael Safioleas, Michael Stamatakos, Constantinos Safioleas, Alkiviades Kostakis, 2nd Department of Propedeutic Surgery, School of Medicine, Athens University, Laiko Hospital, Greece
Constantinos Revenas, Constantinos Chatziconstantinou, Department of Radiology, Laiko Hospital, Athens, Greece
Correspondence to: Professor Michael Safioleas, MD, PhD,7 Kyprou Ave. Filothei, 15237 Athens, Greece. stamatakosmih@yahoo.gr
Telephone: +30-210-6812188
Received: May 27, 2006
Revised: May 28, 2006
Accepted: June 15, 2006
Published online: September 14, 2006
Abstract

Mirizzi syndrome (MS) is an uncommon complication of gallstone disease and occurs in approximately 1% of all patients suffering from cholelithiasis. The syndrome is characterized by extrinsic compression of the common hepatic duct frequently resulting in clinical presentation of intermittent or constant jaundice. Most cases are not identified preoperatively. Surgery is the indicated treatment for patients with MS. We report here a 71-year-old male patient referred to the surgical outpatient department for diffuse upper abdominal pain and mild jaundice (bilirubin rate: 4.2 mg/dL). Ultrasound examination revealed a stone in the cystic duct compressing the common hepatic duct. The patient had a history of gastrectomy for gastric ulcer 30 years ago. MRCP revealed a stone impacted in the cystic duct causing obstruction of the common hepatic duct by extrinsic compression. With these findings the preoperative diagnosis was indicative of MS. At laparotomy a moderately shrunken gallbladder was found embedded in adhesions containing a large stone which was palpable in the common bile duct. The anterior wall of the body of the gallbladder was opened by an incision which extended longitudinally along the gallbladder towards the common bile duct. The stone measuring 3.0 cm in diameter, was then removed setting astride a large communication with the common bile duct. A Roux-en-Y cholecysto-choledocho-jejunostomy was performed. The subhepatic region was drained. The patient had an uneventful recovery. He was discharged eleven days after operation and remained well after a 30-mo follow-up.

Keywords: Benign jaundice, Hepatic duct obstruction, Impacted gallstone, Cholecystobiliary fistula