Coexistent gallbladder carcinoma in Mirizzi syndrome

Abstract

A 52-year-old woman presented with right upper quadrant pain and obstructive jaundice. Computed tomographic scan showed Mirizzi syndrome type 1 and a thickened and calcified gallbladder wall, raising the possibility of coexistent gallbladder carcinoma that was later confirmed on histology post-cholecystectomy.

Síndrome de Mirizzi “un caso bajo el subdiagnóstico”

“…Considerando que para realizar el diagnóstico de síndrome de Mirizzi es demostrativo la presencia de: a) inserción baja del conducto cístico (favorece la obstrucción); b) cálculo impactado a nivel cístico o en cuello vesicular; c) compresión extrínseca por el cálculo sobre el colédoco; y d) ictericia que puede ser intermitente o constante (2,5,6,11) . El paciente de nuestro caso presenta varios de los síntomas y signos mencionados, a saber: a) dolor abdominal de larga data; b) fiebre, c) vómito, d) diarrea; y e) ictericia leve.…”

Enterolitotomía más colecistectomía precoz, una aplicación de cirugía de control de daños para pacientes con íleo biliar

“…Por otra parte, la presencia de cálculos biliares de larga evolución asociada con inflamación crónica en la vesícula se puede asociar con el aumento de la tasa de cán-cer de vesícula, aunque dicho riesgo es tan insignificante que ha dejado de ser argumento para la colecistectomía asintomática 16 .…”

Mirizzi’s syndrome: a diagnostic dilemma

“…Whilst very high levels are usually associated with carcinoma, a case of MZS is reported in which CA19-9 measured over 16,000 U/mL [9]. Although Mirizzi's syndrome can be confused with pancreatic and biliary tumours, the possibility of benign disease like MZS must be considered even with markedly elevated levels of tumour markers since the opportunity for curative surgery may be missed [10]. The best method of diagnosing MZS is not straightforward, as some sources state that ERCP is the gold standard, but others recommend intraductal ultrasound [11,12].…”

“…Chiam et al [10] report a case of Mirizzi's diagnosed on CT but interestingly the patient was found to have gallbladder carcinoma on histological examination following cholecystectomy. This coexistence of MZS with carcinoma is an important point.…”