Mirizzi syndrome with cholecysto-choledocal fistula with a high CA19-9 level mimicking biliary malignancies: a case report.
Mirizzi syndrome type II is a form of obstructive jaundice caused by a stone impacted in the gallbladder neck or the cystic duct that impinges on the common hepatic duct with a cholecysto-choledochal fistula. Preoperative recognition is necessary to prevent injury to the common duct during surgery. We present a patient with an operative diagnosis of type II Mirizzi syndrome, which was not originally indicated in the preoperative work-up; in particular endoscopic retrograde cholangiopancreatography showed stenosis of the middle third of the hepatic duct along with markedly elevated serum CA19-9 levels (up to 35,000 U/mL). Surgical specimen examination did not reveal the presence of neoplasia. We performed cholecystectomy and a jejunal loop was brought up and anastomosed to the common duct at the hilar level in a Roux-en-Y fashion. In cases such as ours with extensive fibrosis and inflamed tissue mimicking cholangiocarcinoma or gallbladder carcinoma, a wide hepaticojejunostomy is required to establish adequate biliary drainage.
Department of Surgery and Transplantation, University of Bologna, Italy. aprincipe@orsola-malpighi.med.unibo.it
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Principe
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Del Gaudio
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GL
Grazi
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Paolucci
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Cavallari
D018395:CA-19-9 Antigen / Q000097:blood*; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy; D006801:Humans; D007412:Intestinal Fistula / Q000097:blood* / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013577:Syndrome
D018395:CA-19-9 Antigen