Cholecystocolonic fistula: A rare case report of Mirizzi syndrome

C.A Esparza Monzavi,X Peters,M Spaggiari

doi:10.1016/j.ijscr.2019.09.023

C.A Esparza Monzavi, X Peters + Show 1 more

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https://doi.org/10.1016/j.ijscr.2019.09.023

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Abstract

IntroductionMirizzi syndrome is a rare complication of gallstone disease that more rarely is associated with the formation of cholecystoenteric fistula. Presentation of caseThe patient presented with a five-day history of abdominal pain in the right upper quadrant (RUQ), nausea, and emesis. Further ultrasound (US) imaging demonstrated a large gallstone with associated thickened gallbladder with pericholecystic fluid. Computed tomography (CT) imaging, preoperative Hepatobiliary Scintigraphy and Endoscopic Retrograde Cholangiopancreatography (ERCP) displayed findings consistent with a Csendes type IV Mirizzi syndrome associated with cholecystocolonic fistula. Description of surgical approach, management and outcome is presented. DiscussionSurgical management of Mirizzi syndrome varies by classification of its severity. Open operation is preferred in cases with severe inflammation and concern for malignancy. The patient underwent a cholecystocolonic fistula takedown. A cholecystectomy was attempted though aborted due to concerns of malignancy. Biopsies returned negative for malignancy and the patient demonstrated findings on ERCP consistent with Mirizzi syndrome.Stenting of the common bile duct (CBD) was performed with ERCP and later the patient underwent an open biliary exploration with subsequent choledochotomy, biliary stone removal, and primary closure with interrupted sutures using remnant gallbladder wall flaps. ConclusionTo our knowledge, Mirizzi syndrome with concurrent cholecystocolonic fistula is exceedingly rare with a paucity of reports within the literature. Our report discusses principles of management of Mirizzi syndrome as well as best practices of surgical management for Mirizzi syndrome with concurrent cholecystocolonic fistula.

Highlights

Mirizzi syndrome is a rare complication of gallstone disease that more rarely is associated with the formation of cholecystoenteric fistula
Eponymously documented in 1948, is widely known amongst the surgical community to denote the circumstance by which a large gallstone in the gallbladder neck or cystic duct leads to a narrowing of the common hepatic duct [1]
The McSherry classification schema dichotomized the syndrome, denoting type I as external compression of the bile duct by a large stone, and type II as a cholecystobiliary fistula caused by such a stone or stones [7]

Summary

Introduction

Mirizzi syndrome is a rare complication of gallstone disease that more rarely is associated with the formation of cholecystoenteric fistula. Computed tomography (CT) imaging, preoperative Hepatobiliary Scintigraphy and Endoscopic Retrograde Cholangiopancreatography (ERCP) displayed findings consistent with a Csendes type IV Mirizzi syndrome associated with cholecystocolonic fistula. Mirizzi syndrome concurrent with cholecystoenteric fistula is an even rarer occurrence and may or may not include an associated gallstone ileus [2,3]. Of those patients found to have both Mirizzi syndrome as well as cholecystoeneteric fistula, reports have included cholecystoduodenal fistula as well as cholecystogastric fistula. The patient was discovered to have advanced Csendes type V Mirizzi with a chole-

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