title: Mirizzi syndrome complicating an anomalous biliary tract: a novel cause of a hugely elevated CA19-9.
abstract: A 71-year-old man presented with painful obstructive jaundice, weight loss and an elevated CA19-9 (>16,000 U/ml) (normal levels <39 U/ml). Imaging showed a hilar mass. After biliary stenting, the CA19-9 returned to normal. At surgery, biliary obstruction owing to a gallstone (Type II Mirizzi) was found to be complicating a congenital biliary tract anomaly. The obstructing stone was removed and the anomalous biliary tract reconstructed with a Roux-en-y loop, and the patient made an uneventful recovery and remained normal over a 2-year follow-up. A Type II Mirizzi with a biliary tract anomaly is an undocumented cause of an elevated CA19-9. The possibility of benign disease must be considered even with very high levels of the cancer marker CA19-9 or the opportunity for curative surgery may be missed.
authors.affiliation: University Department of Surgery, Royal Free Hospital & Royal Free & University College School of Medicine, University College London, UK.
authors.forename: Andrew G N
authors.initials: AG
authors.lastname: Robertson
authors.forename: Brian R
authors.initials: BR
authors.lastname: Davidson
mesh_terms: D000368:Aged; D001659:Biliary Tract / Q000002:abnormalities*; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood*; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D005706:Gallbladder Neoplasms / Q000175:diagnosis*; D042882:Gallstones / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D008297:Male; D013577:Syndrome
chemical_list: D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen