Mirizzi syndrome in a patient with partial gastrectomy with Billroth II anastomosis: A case report
| Autor: | Giuseppina Ferro, Giovanna Rizzo, Carmelo Sciumè, Giacomo Emanuele Maria Rizzo, Giovanni Corbo, Giovanni Di Carlo |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment 03 medical and health sciences ERCP 0302 clinical medicine Cholangiography Gastrectomy Case report medicine Billroth I Billroth II Endoscopic retrograde cholangiopancreatography medicine.diagnostic_test Common bile duct business.industry Gallbladder Mirizzi syndrome medicine.anatomical_structure 030220 oncology & carcinogenesis Cystic duct 030211 gastroenterology & hepatology Surgery Laparoscopy Radiology business Billroth |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| Popis: | Highlights • Obstructive jaundice may be a challenge for differential diagnosis. • Mirizzi Syndrome may simulate clinical and radiological presentation of common bile duct stones. • ERCP hardly achieves cannulation of biliary duct in altered anatomy, so gastroscope may be a correct choice in these cases. • Surgical treatment is essential in Mirizzi Syndrome. Introduction Mirizzi Syndrome (MS) is a common bile duct (CBD) obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder. Radiological evaluation may mistake it for CBD stones in jaundiced patient, especially in those who have altered anatomy of upper gastrointestinal (e.g. sub-total gastrectomy – STG – with Billroth I or II anastomosis). Presentation of case A 69-year-old male with a history of STG Billroth-II 25 years prior, accessed hospital for abdominal pain and jaundice with increasing in hepatic laboratory tests. Ultrasound of abdomen, CT scan and MRCP diagnosed CBD stones, so endoscopic retrograde cholangiopancreatography (ERCP) was performed, using a gastroscope to reach papillary region and to achieve cannulation of biliary duct. During cholangiography patient resulted affected by Mirizzi syndrome type I, so laparoscopic cholecystectomy was performed and cystic duct was moved away. Discussion This rare case shows how it’s easy to delay the correct treatment when a wrong radiological diagnosis is made. Moreover, ERCP remains a challenging procedure in patients with altered anatomy, such as STG B–II, and in this case gastroscope was needed for cannulation, due to the need of frontal view. Conclusion This rare case report highlights the importance of not forgetting MS in the differential diagnosis of biliary obstruction, especially in those patients with upper GI altered anatomy. Physicians with expertise in ERCP should always consider altered anatomy as a factor which may confuse radiologist in diagnosis, so in this case MS may be discovered or confirmed at ERCP. |
| Databáze: | OpenAIRE |
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