Kostas G. Tsalis, Emmanouil Zacharakis, Ioanna E. Kirou, Nikolaos Sapidis, Ioannis Vagios, Stavros Kalfadis, Dimitrios Betsis
Med Sci Monit 2009; 15(3): CS54-57
Available online: 2009-02-21
A rare case of Mirizzi syndrome with atypical presentation is reported.
Material and Method: An 81-year-old woman with a known history of cholelithiasis presented with epigastric discomfort and indigestion. Imaging investigations revealed Mirizzi syndrome, while a cholecystobiliary fistula at the junction of the hepatic ducts was recognized intraoperatively and treated successfully with cholecystectomy and Roux-en-Y hepaticojejunostomy. During two years' follow-up the patient remains free of biliary symptoms.
Conclusions: Diagnosis of Mirizzi syndrome requires a high degree of clinical suspicion, especially in cases without obstructive jaundice. A fistula at the level of the confluence of the hepatic ducts is a rare topographic variant of the syndrome that may need a totally different surgical approach.
Keywords: Tomography, X-Ray Computed, Hepatic Duct, Common - ultrasonography, Gallstones - radiography, Fistula - ultrasonography, Cholelithiasis - ultrasonography, Cholangiopancreatography, Magnetic Resonance, Syndrome, Anastomosis, Roux-en-Y, Abnormalities, Multiple - ultrasonography