Post-Cholecystectomy Mirizzi Syndrome: A Case Report and Review of the Literature

Abstract

Patient: Female, 44Final Diagnosis: Post-cholecystectomy Mirizzi syndromeSymptoms: Abdominal pain • nausea • vomitingMedication: Tramadol • hydromorphone • prochlorperazineClinical Procedure: US • MRCP • ERCP• choledochoscopySpecialty: Gastroenterology and HepatologyObjective:Management of emergency careBackground:Mirizzi syndrome is biliary obstruction caused by extrinsic compression of the distal common hepatic duct by a gallstone in the adjacent cystic duct or infundibulum of the gallbladder. Post-cholecystectomy Mirizzi syndrome (PCMS) is Mirizzi syndrome in the post-surgical absence of a gallbladder. This case report of PCMS and review of the literature illustrates the diagnostic and therapeutic challenges in evaluating and managing Mirizzi syndrome.Case Report:A 44-year-old female with a remote history of laparoscopic cholecystectomy presented to a community teaching hospital with acute and severe upper abdominal pain and tenderness. Laboratory data revealed markedly elevated transaminases of a magnitude most often observed with hepatitis from acute viral infection, ischemia, or exposure to a hepatotoxin. PCMS was ultimately diagnosed at endoscopic retrograde cholangiopancreatography after being misdiagnosed as choledocholithiasis on magnetic resonance cholangiopancreatography. After transfer to an academic quaternary care referral hospital, the patient’s extrahepatic biliary tree was reportedly cleared of gallstones following endoscopically-directed shock-wave lithotripsy performed at repeat endoscopic retrograde cholangiography.Conclusions:Recognizing post-cholecystectomy syndrome, in general, and PCMS, in particular, is critical when caring for patients presenting with persistent or recurrent symptoms or signs of biliary obstruction following cholecystectomy. Expediently identifying and definitively relieving the biliary obstruction, while limiting the risk of iatrogenic complication, is the priority when caring for patients with PCMS.

Síndrome de Mirizzi tipo V: manejo laparoscópico

“…La literatura actual discrepa sobre el manejo de esta condición, afirmando que la cirugía laparoscópica no es segura como procedimiento estándar, y mucho menos, en pacientes con enfermedad avanzada (10)(11)(12). Sin embargo, en los últimos años esta técnica se ha posicionado como una opción de tratamiento por sus excelentes resultados.…”

Postcholecystectomy syndrome: a case report

“…2 The term postcholecystectomy syndrome (PCS) is referred to as the presence of signs and symptoms after an interventional cholecystectomy. 3 The definition is not explained elsewhere and sometimes mixed up with extra biliary disorders if they cause symptoms similar to postcholecystectomy.…”

“…4 Generally, PCS occurs due to the modifications in bile flow owing to loss of the reservoir function of the gall bladder as a result of which patients report to have mild gastroduodenal symptoms of diarrhoea. 3 The management of PCS is usually symptomatic based on the cause. 5…”

Electrohydraulic Lithotripsy in the Treatment of the Mirizzi Syndrome. A Clinical Case

“…Синдром Мириззи является редким и трудно диагностируемым осложнением желчнокаменной болезни. По данным литературы, он встречается в среднем у 0,25-6% больных с разными формами желчнокаменной болезни [1,[3][4][5][6]. До оперативного вмешательства он верно диагностируется, с использованием всего комплекса передовых методов, только в 12,5-22% случаев [1][2][3][4][5][6][7].…”

“…Последующее развитие патологического процесса приводит к формированию стриктуры или же формированию холецисто-билиарного свища. [2,3]. Синдром Мириззи был назван в честь аргентинского хирурга Pablo Mirizzi, который описал его в 1948 году.…”