[Transduodenal sphincterotomy and type II Mirizzi syndrome]

This paper describes the clinical course of a 76-year-old woman surgically treated in our department (General Surgery) for obstructive jaundice in Mirizzi syndrome (II). Ultrasonography and ERCP failed to demonstrate the pathological situation at the level of the biliary tree. When laparotomy was decided because of the progressive worsening of the general clinical conditions of the patient, intraoperative cholangiography showed the presence of a cholecystocholedochal fistula with multiple residual stones eroded into the common bile duct. Surgical management consisted of partial cholecystectomy, removal of the stones, choledochoplasty and exploration of the distal part of the common bile duct by a transduodenal sphincteroplasty. The post-operative period was uneventful and the patient was discharged from our department nine days after surgery. Even though the surgical approach to Mirizzi syndrome generally includes procedures other than papillosphincteroplasty+partial cholecystectomy, our experience seems to substantiate the efficacy of the previously mentioned treatment under suitable conditions.