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A Case of Mirizzi Syndrome with Pancreatic Divisum: A rare association
Divya Muthuvel1, Anita Soundarapandian1
1Department of Radiodiagnosis, Panimalar Medical College Hospital and Research Institute, Chennai, India.
Abstract:
Mirizzi syndrome (MS), a rare complication of gallstones, refers to extrahepatic biliary compression by calculus in the cystic duct or Hartman's pouch and is usually associated with cystic duct abnormalities. Its association with pancreatic divisum (PD) is infrequent, the most common complication of PD being recurrent pancreatitis. We report a 39-year-old female patient who presented to a department of general surgery in Chennai, India, in 2022 with acute abdominal pain. Magnetic resonance cholangiopancreaticography (MRCP) showed calculous cholecystitis with a calculus indenting the cystic duct, causing luminal narrowing of the common hepatic duct (type I), which was associated with type II PD. The association of MS with PD has been rarely described. PD may be one of the factors responsible for bile stasis leading to calculous cholecystitis and its complications. Knowledge of MS and its associations helps in early diagnosis and selection of appropriate treatment management.
Insights
Mirizzi syndrome, a rare gallstone complication, can occur with pancreatic divisum. This case highlights their infrequent association and potential link to bile stasis, aiding diagnosis.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
Background:
- Mirizzi syndrome (MS) involves biliary compression from gallstones in the cystic duct or Hartman's pouch.
- Pancreatic divisum (PD) is a common congenital anomaly, typically causing recurrent pancreatitis.
Observation:
- A 39-year-old female presented with acute abdominal pain.
- MRCP revealed type I Mirizzi syndrome compressing the common hepatic duct and type II pancreatic divisum.
Findings:
- This case details the rare co-occurrence of Mirizzi syndrome and pancreatic divisum.
- The patient's presentation involved gallstone-induced biliary obstruction and a pancreatic duct anomaly.
Implications:
- Pancreatic divisum may contribute to bile stasis, increasing the risk of gallstone disease and Mirizzi syndrome.
- Recognizing this association is crucial for accurate diagnosis and effective treatment planning.
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