Surgical management of cholecystoduodenal fistula complicated by ileus (Mirizzi syndrome type Vb). A case report

Abstract

 

Mirizzi Syndrome (MS) is a rare gallbladder disease described by Argentine surgeon, Pablo Luis Mirizzi in 1948. It concerns a wide range of clinical manifestations, including gallstone obstruction of the intestine. The modified classification by Csendes distinguishes five types of MS. The case described by the authors of this paper could be classified as type Vb, which means MS with a complication of obstruction. A 74-year-old woman with nonspecific, permanent, diffuse abdominal pain and bile vomiting was admitted to the emergency department where conservative treatment was administered. Based on the preoperative diagnosis of ileus, the patient was qualified for a laparotomy. The patient had a cholecystoduodenal fistula which was responsible for the displacement of the stone into the intestinal lumen and consequently for the mechanical obstruction of the intestine. It must be taken into account that the clinical manifestation of MS may be biliary obstruction, as occurred in the case presented below. Biliary symptoms may occur, but this is not a common situation, whereas half of patients with an obstruction have a history of biliary disease. The case presented here can be a valuable lesson in being mindful of the possibility of elderly and female patients developing biliary obstruction, even without having a history of chronic gallstone disease. Therefore, a meticulous intraoperative inspection should be performed in such cases in order to search for possible fistulas.