Conservative Management of Mirizzi Syndrome in Community Hospital Setting

Area of Science:

• Hepatobiliary Surgery
• Surgical Gastroenterology
• Abdominal Imaging

Background:

• Mirizzi syndrome (MS) is a rare complication of chronic cholecystitis, characterized by gallbladder wall compression of the common hepatic duct (MS1) or a cholecystocholedochal fistula (MS2).
• The condition presents with obstructive jaundice and abdominal pain, often leading to preoperative misdiagnosis due to non-specific symptoms.
• Its incidence in symptomatic cholelithiasis is notably low.

Observation:

• A 76-year-old female, initially diagnosed with chronic cholecystitis, was unexpectedly found to have MS2 intraoperatively.
• The patient had no prior history of abdominal surgery or biliary instrumentation.
• She underwent a subtotal cholecystectomy with common bile duct exploration, t-tube placement, and local drainage.

Findings:

• The patient recovered well, with drains removed after diminished output and no biloma on CT scan.
• T-tube cholangiography at two months confirmed contrast passage into the duodenum, allowing for t-tube removal at three months.
• This case supports subtotal cholecystectomy with biliary drainage as a safe and effective management strategy for MS2.

Implications:

• Surgical management of MS2 is complex and requires careful consideration of anatomical and pathological factors.
• While biliary-enteric reconstruction is common, a conservative approach with subtotal cholecystectomy and drainage offers a viable alternative.
• General surgeons must be familiar with the conservative management of Mirizzi syndrome, particularly when discovered intraoperatively.