Mirizzi Syndrome - Rare Cause of Major Biliary Complications . Case Report

ABSTRACT: Mirizzi syndrome is a rarely observed complication of gallstone disease, causing major biliary problems, if not diagnosed previously. It was described in 1948 by P. L. Mirizzi and presents unusual lodged gallstone in either the cystic duct or most frequently in Hartmann pouch of the gallbladder. Impaction, acute obstruction and wall ischemia are causative for inflammation and abscess formation. External common hepatic bile duct compression and obstruction result in clinical presentation of intermittent or constant jaundice. We report 57-year-old male with extensive mechanical icter, fever, nausea and vomiting, and upper abdominal pain in epigastria from five days. Abdominal US evaluation showed 17mm stone localized in infundibulum and shrunk of gallbladder. MRCT revealed impacted stone, chronic tissue inflammation, involved common hepatic duct with stricture. Mirizzi syndrome was diagnosed. Intraoperatively was found an impacted gallstone in the Hartmann pouch, extensive fibrosis of hepatoduodenal ligament and abscess cavity formation in the Callot’s triangle with engagement of common hepatic bile duct wall. Antegrade cholecystectomy was made and T drain was placed. Second operation and Roux-Y limb anastomosis was performed after unsuccessful tentative for recanalization of distal CBD with clamping of T drain.