Laparoscopic subtotal cholecystectomy for Mirizzi syndrome: A report of a case

Jiro Kimura,Naokazu Takata,Alan Kawarai Lefor,Masaki Kanzaki,Ken Mizokami

doi:10.1016/j.ijscr.2019.01.010

Abstract

IntroductionMirizzi syndrome is a rare complication of gallstone disease. The purpose of this report is to describe the utility of laparoscopic subtotal cholecystectomy for Mirizzi syndrome. Presentation of caseA 53-year-old female presented with dark urine and right upper quadrant pain. Blood tests revealed elevated liver and biliary enzyme levels. Magnetic resonance cholangiopancreatography showed a narrowed common hepatic duct compressed by a large gallstone, consistent with Mirizzi syndrome. Semi-urgent laparoscopic cholecystectomy was planned. At operation, circumferential dissection of the gallbladder neck was difficult. The fundus of the gallbladder was opened and a 2 cm stone extracted. The gallbladder neck was sutured and a drain placed. The postoperative clinical course was uneventful. DiscussionAfter laparoscopic cholecystectomy in patients with Mirizzi syndrome, complication rates, including bile duct injuries, is high. In patients with Mirizzi syndrome, removal of the responsible stone is the main purpose of treatment. ConclusionLaparoscopic subtotal cholecystectomy is a useful technique for patients with Mirizzi syndrome to avoid bile duct injury.

Highlights

Mirizzi syndrome is a rare complication of gallstone disease
It was named after Pablo Mirizzi, who defined the syndrome as a benign common hepatic duct obstruction due to gallstone impaction in the gallbladder neck resulting in local inflammation and bile duct spasm [3]
Mirizzi syndrome was attributed to extrinsic compression of the common hepatic duct by gallstones impacted in the cystic duct or the gallbladder neck [4]

Summary

INTRODUCTION

Mirizzi syndrome is a rare complication of gallstone disease. The purpose of this report is to describe the utility of laparoscopic subtotal cholecystectomy for Mirizzi syndrome. Magnetic resonance cholangiopancreatography showed a narrowed common hepatic duct compressed by a large gallstone, consistent with Mirizzi syndrome. Circumferential dissection of the gallbladder neck was difficult. The fundus of the gallbladder was opened and a 2 cm stone extracted. The gallbladder neck was sutured and a drain placed. DISCUSSION: After laparoscopic cholecystectomy in patients with Mirizzi syndrome, complication rates, including bile duct injuries, is high. In patients with Mirizzi syndrome, removal of the responsible stone is the main purpose of treatment. CONCLUSION: Laparoscopic subtotal cholecystectomy is a useful technique for patients with Mirizzi syndrome to avoid bile duct injury

Presentation of a case

Discussion

Findings

Ethical approval