Zachary Walker, Kejal Shah, MD, Michael P Meara, MD, MBA, FACS. The Ohio State University Wexner Medical Center
Background: Complicated Cholelithiasis can result in episodes of cholangitis and Mirizzi syndrome, extrinsic compression of the common hepatic duct by a stone in the cystic duct or gallbladder. Endoscopic retrograde cholangiopancreatography (ERCP) can be used for diagnosis and stent placement to temporarily treat Mirizzi syndrome. Cholecystectomy remains the definitive treatment for Mirizzi syndrome. Chronic inflammation in Mirrizi syndrome can result in fibrosis of surrounding tissues complicating resection and increasing risk of iatrogenic bile duct injury and intraperitoneal bleeding. The subject of this case study presented with extensive fibrosis extending O.R time.
Case Presentation: A 35-year-old Caucasian female presented to the emergency department jaundiced with right upper quadrant pain and emesis for three days. Her vital signs were within normal limits. Her history was significant for the previous diagnosis of cholelithiasis with subsequent common bile duct (CBD) stent placement two years prior. Ultrasound lead to the diagnosis of choledocholithiasis with common bile duct dilation to 11mm on date of admission. An ERCP was performed on the day of admission with the removal and replacement of the previous stent. ERCP lead to suspicion of Mirizzi syndrome due to apparent hepatic duct filling defect which was confirmed on MRI. Three weeks later a robotic cholecystectomy was performed with an operative time of two hours and fifteen minutes. One week postoperative symptoms resolved with no complications.
Conclusions: Mirizzi syndrome can cause repeated inflammation of the cystic walls and subsequent fibrosis may cause adherence to nearby structures (1,7), which complicated this procedure. Avoiding extensive fibrosis and inflammation with appropriately timed surgery in calculous cholecystitis may decrease complications.
Keywords: Mirizzi Syndrome, Choledocholithiasis, robotic cholecystectomy
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95938
Program Number: P211
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster