1. An alternative treatment for postcholecystectomy Mirizzi's syndrome: cystic duct balloon dilation
- Author
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Erkin Öztaş, Serkan Torun, Ertuğrul Kayaçetin, Bülent Ödemiş, Ufuk Barış Kuzu, and Muhammet Yener Akpinar
- Subjects
medicine.medical_specialty ,Balloon ,digestive system ,Cholangiography ,Recurrence ,medicine ,Humans ,Aged ,Mirizzi's syndrome ,Cholangiopancreatography, Endoscopic Retrograde ,Endoscopic retrograde cholangiopancreatography ,Common bile duct ,medicine.diagnostic_test ,business.industry ,Gastroenterology ,Cystic Duct ,Jaundice ,medicine.disease ,Mirizzi Syndrome ,Dilatation ,Surgery ,surgical procedures, operative ,medicine.anatomical_structure ,Cholecystectomy, Laparoscopic ,Balloon dilation ,Cystic duct ,Female ,medicine.symptom ,business - Abstract
Postcholecystectomy Mirizzi’s syndrome is an extremely rare condition that is caused by a stone in the cystic duct remnant. Remnant cystic duct calculus could be due to either a retained stone or recurrence of a stone [1]. A 68-year-old woman with jaundice, fever, and abdominal pain was admitted to our hospital. She had been diagnosed with type-1 Mirizzi’s syndrome 8 months previously and had undergone laparoscopic cholecystectomy. Laboratory studies at our hospital revealed the following results: leukocyte count 27430, alanine aminotransferase 88U/L, aspartate aminotransferase 173U/L, gamma glutamyl transferase 484U/L, lactate dehydrogenase 624U/L, total serum bilirubin 7.36mg/dL, and direct serum bilirubin 5.67mg/dL. She underwent endoscopic retrograde cholangiopancreatography (ERCP). During cholangiography, a stone measuring nearly 1cmwas observed at the junction of the common bile duct (CBD) and cystic duct stump, causing compression of the CBD (●" Fig.1a). The stone could not be extracted with a balloon or captured by a basket despite several attempts at retrieval. The junction of the CBD and cystic duct was therefore dilated using a 12-mm balloon (●" Fig.1b), and the stone was removed using an extraction balloon (●" Fig.1c). The removal of the stone was confirmed by cholangiography (●" Fig.1d). This is the first case in the literature describing balloon dilation at the junction of the CBD and cystic duct stump for the treatment of postcholecystectomy Mirizzi’s syndrome. Although ERCP is traditionally used before surgery [2], we consider that this is an effective and safe alternative method for the treatment of postcholecystectomy Mirizzi’s syndrome.
- Published
- 2015