Post-Cholecystectomy Mirizzi Syndrome: A Case Report and Review of the Literature
| Autor: | Carolina Borz-Baba, Dylan A. Levy, Matthew E. Cohen |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
medicine.medical_specialty Postcholecystectomy syndrome medicine.medical_treatment Gallstones 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Lithotripsy Humans Medicine Cholangiopancreatography Endoscopic Retrograde Magnetic resonance cholangiopancreatography Endoscopic retrograde cholangiopancreatography medicine.diagnostic_test business.industry Gallbladder Articles General Medicine Mirizzi Syndrome medicine.disease Surgery medicine.anatomical_structure Cholecystectomy Laparoscopic Common hepatic duct 030220 oncology & carcinogenesis Cystic duct Female Cholecystectomy business Postcholecystectomy Syndrome |
| Zdroj: | The American Journal of Case Reports |
| ISSN: | 1941-5923 |
| DOI: | 10.12659/ajcr.916364 |
| Popis: | Patient: Female, 44 Final Diagnosis: Post-cholecystectomy Mirizzi syndrome Symptoms: Abdominal pain • nausea • vomiting Medication: Tramadol • hydromorphone • prochlorperazine Clinical Procedure: US • MRCP • ERCP• choledochoscopy Specialty: Gastroenterology and Hepatology Objective: Management of emergency care Background: 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. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|