Korean J Gastrointest Endosc.  1997 Jun;17(3):437-442.

A Case of Mirizzi Syndrome with Choecystocholedochal Fistula

• Kim KJ
• Dong SH
• Park HJ
• Kim WS
• Kim HJ
• Kim BH
• Chang YW
• Lee JI
• Chang R

Abstract

The Mirizzi syndrome, obstructive jaundice due to inflammatory or direct compression of common duct is an uncommon complication of longstanding cholecystitis, caused by a cystic duct stone or impacted stone of gallbladder neck. Mirizzi syndrome with resulting repeated attack of inflammation and pressure necrosis leads to the formation of cholecystocholedochal fistulas, rarely(Mirizzi syndrome type II), The cholecystocholedochal fistula is very difficult to recognize on preoperative state, and constitute a high risk of damage to the common duct during a cholecystectomy, Since jaundice is the main problem, abdominal sonography and following ERCP(Endoscopic retrograde cholangiopan-creatography) are the primary radiologic tests. But. these findings are so non-specific that exact diagnosis is made in operation room, frequently. We experienced a 67-year-old male patient who complained repeated right upper quadrant pain. On his sonography, dilatation of intrahepatic and common hepatic duct showed and stone was likely to place in the proximal common duct, but gallbladder and cystic duct was not visualized. In operation the gallbladder was identified likely to diverticulum on the common duct and large fistula was present between them. Partial cholecystectomy and Roux-en Y choledochojejunostomy was done. The patient fell in sepsis and discharged hopelessly.

Keyword

Mirizzi syndrome; Cholecystocholedochal fistula; Endoscopic retrograde cholangiopancreatography

MeSH Terms

Aged
Cholangiopancreatography, Endoscopic Retrograde
Cholecystectomy
Cholecystitis
Choledochostomy
Cystic Duct
Diagnosis
Dilatation
Diverticulum
Fistula*
Gallbladder
Hepatic Duct, Common
Humans
Inflammation
Jaundice
Jaundice, Obstructive
Male
Mirizzi Syndrome*
Neck
Necrosis
Sepsis