Mirizzi syndrome mimicking cholangiocarcinoma. Case report

Abstract

Mirizzi syndrome (MS) is a rare condition whose clinical presentation is unspecific, with obstructive jaundice being the most common form. MS is often not recognized at initial presentation, which can result in morbidity and biliary injury. Preoperative diagnosis is uncommon and over 50% of patients with MS are diagnosed during surgery. There are no clinical features to distinguish MS from cholangiocarcinoma, except that patients with cholangiocarcinoma are on average ten years older than patients with MS. We report the case of a 51-year-old female patient who presented with jaundice and weight loss. Following investigation with laboratory and imaging exams, the initial diagnosis was Bismuth II cholangiocarcinoma. The patient underwent surgical intervention, and anatomopathological examination of the specimen showed the correct diagnosis to be MS. Despite the rarity of its incidence, physicians must keep MS in mind as a possible differential diagnosis for cholangiocarcinoma and vice-versa. We discuss this case in the context of a brief review of the literature on Mirizzi syndrome mimicking cholangiocarcinoma.

Mirizzi syndrome-differential diagnosis with cholangiocarcinoma: case report

“…It was described by Kehr in 1905, later described by Ruge in 1908 and finally in 1948 by Pablo Luis Mirizzi as an inflammatory process secondary to a pressure ulcer caused by an impacted lithium at the level of the infundibulum, generating obstruction of the main bile duct, erosion and a fistula between both structures or the digestive tract. 1,2 Clinical picture is nonspecific, with the appearance of jaundice of obstructive pattern (60-100%), accompanied by abdominal pain in the right upper quadrant (50-100%) and fever in patients with presence of cholelithiasis. Laboratory studies present with hyperbilirubinemia of direct predominance and in some patients, there may be elevation of the tumor marker CA 19-9.…”