AN OPERATED CASE OF MIRIZZI SYNDROME PRESENTING WITH STENOSIS EXTENDING TO THE INTRAHEPATIC DUCTS

An operated case of Mirizzi syndrome presenting with stenosis extending to the intrahepatic ducts is reported.A 63-year-old man presented with a sudden onset of jaundice and fever. Laboratory data revealed a total bilirubin of 12.1 mg/dl. Ultrasonography and CT revealed gallstones within the gallbladder and marked wall thickness of the neck and solid mass continuous with the gallbladder in the liver. ERCP demonstrated the obstruction of the cystic duct and a 5 cm smooth stricture of the common hepatic duct. Administration of antibiotics improved his complaints and total bilirubin decreased to 2.2 mg/dl, however, ERCP performed again after the improvement showed a progression of the stricture and additionally stenosis of the intrahepatic ducts.At surgery, the gallbladder neck and porta hepatis formed a mass. However, intraoperative ultrasonography revealed a gallstone impacted in the neck of the gallbladder and no invasive lesions in the liver, accordingly presumptive intraoperative diagnosis of Mirizzi syndrome was made. Cholecystectomy with partial hepatectomy including the gallbladder bed, and resection of the biliary tract were performed. The postoperative course was uneventful. Pathologic histology revealed chronic cholecystitis and marked fibrosis of the biliary tract and no malignant change was found.