Combined Endoscopic and Laparoscopic Management of Postcholecystectomy Mirizzi Syndrome from a Remnant Cystic Duct Stone: Case Report and Review of the Literature.

Arpit Amin,Yuriy Zhurov,Jonathan Giannone,Anthony Maffei,George Ibrahim,Thomas Cerabona,Ashutosh Kaul

doi:10.1155/2016/1896368

Abstract

Mirizzi syndrome has been defined in the literature as common bile duct obstruction resulting from calculi within Hartmann's pouch or cystic duct. We present a case of a 78-year-old female, who developed postcholecystectomy Mirizzi syndrome from a remnant cystic duct stone. Diagnosis of postcholecystectomy Mirizzi syndrome was made on endoscopic retrograde cholangiography (ERCP) performed postoperatively. The patient was treated with a novel strategy by combining advanced endoscopic and laparoscopic techniques in three stages as follows: Stage 1 (initial presentation): endoscopic sphincterotomy with common bile duct stent placement; Stage 2 (6 weeks after Stage 1): laparoscopic ultrasonography to locate the remnant cystic duct calculi followed by laparoscopic retrieval of the calculi and intracorporeal closure of cystic duct stump; Stage 3 (6 weeks after Stage 2): endoscopic removal of common bile duct stent along with performance of completion endoscopic retrograde cholangiogram. In addition, we have performed an extensive review of the various endoscopic and laparoscopic management techniques described in the literature for the treatment of postcholecystectomy syndrome occurring from retained cystic duct stones.

Highlights

Mirizzi syndrome has been defined as bile duct obstruction from stone impaction in Hartman’s pouch or cystic duct [1]
Mirizzi syndrome due to remnant cystic duct calculi should be considered in the differential diagnosis of patients presenting with postcholecystectomy syndrome
Diagnosis of this rare entity can be confirmed with the help of abdominal ultrasonography and magnetic resonance cholangiopancreatography (MRCP) in the correct clinical scenario

Summary

Introduction

Mirizzi syndrome has been defined as bile duct obstruction from stone impaction in Hartman’s pouch or cystic duct [1]. Mirizzi syndrome has been well-described in the literature in patients with a reported incidence of 0.7–1.4% [2]. There is a paucity of literature describing Mirizzi syndrome after patients have undergone cholecystectomy and subsequent management of this entity. We describe a minimally invasive combined endoscopic and laparoscopic management of Mirizzi syndrome occurring from a retained cystic duct stump stone in a patient after laparoscopic cholecystectomy. A literature review on the topic of retained cystic duct stone after cholecystectomy was performed to highlight the diagnostic and therapeutic options available in management of this entity

Case Presentation

Findings

Discussion

Conclusion