Mirizzi syndrome with cholecysto-choledocal fistula with a high CA19-9 level mimicking biliary malignancies: A case report

Alfonso Principe, M. Del Gaudio, G. L. Grazi, U. Paolucci, A. Cavallari

Research output: Contribution to journalArticle

Abstract

Mirizzi syndrome type II is a form of obstructive jaundice caused by a stone impacted in the gallbladder neck or the cystic duct that impinges on the common hepatic duct with a cholecysto-choledochal fistula. Preoperative recognition is necessary to prevent injury to the common duct during surgery. We present a patient with an operative diagnosis of type II Mirizzi syndrome, which was not originally indicated in the preoperative work-up; in particular endoscopic retrograde cholangiopancreatography showed stenosis of the middle third of the hepatic duct along with markedly elevated serum CA19-9 levels (up to 35.000U/mL). Surgical specimen examination did not reveal the presence of neoplasia. We performed cholecystectomy and a jejunal loop was brought up and anastomosed to the common duct at the hilar level in a Roux-en-Y fashion. In cases such as ours with extensive fibrosis and inflamed tissue mimicking cholangiocarcinoma or gallbladder carcinoma, a wide hepaticojejunostomy is required to establish adequate biliary drainage.

Original languageEnglish
Pages (from-to)1259-1262
Number of pages4
JournalHepato-Gastroenterology
Volume50
Issue number53
Publication statusPublished - Sep 2003

Keywords

  • Biliary cancer
  • Cholangiography
  • Cholelithiasis
  • Diagnosis
  • Gallbladder
  • Mirizzi syndrome

ASJC Scopus subject areas

  • Gastroenterology

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