Mirizzi syndrome with a fistula at the confluence of the hepatic ducts.
BACKGROUND
A rare case of Mirizzi syndrome with atypical presentation is reported.


METHODS
An 81-year-old woman with a known history of cholelithiasis presented with epigastric discomfort and indigestion. Imaging investigations revealed Mirizzi syndrome, while a cholecystobiliary fistula at the junction of the hepatic ducts was recognized intraoperatively and treated successfully with cholecystectomy and Roux-en-Y hepaticojejunostomy. During two years' follow-up the patient remains free of biliary symptoms.


CONCLUSIONS
Diagnosis of Mirizzi syndrome requires a high degree of clinical suspicion, especially in cases without obstructive jaundice. A fistula at the level of the confluence of the hepatic ducts is a rare topographic variant of the syndrome that may need a totally different surgical approach.
Tsalis
Kostas G
KG
4th Surgical Department, Aristotle University of Thessaloniki, G. Papanikolaou General Hospital, Exohi, Thessaloniki, Greece. Ctsalis@med.auth.gr
Zacharakis
Emmanouil
E
Kirou
Ioanna E
IE
Sapidis
Nikolaos
N
Vagios
Ioannis
I
Kalfadis
Stavros
S
Betsis
Dimitrios
D
D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging / Q000473:pathology*; D000368:Aged; D000713:Anastomosis, Roux-en-Y; D049448:Cholangiopancreatography, Magnetic Resonance; D002769:Cholelithiasis / Q000150:complications / Q000000981:diagnostic imaging; D005260:Female; D005402:Fistula / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D042882:Gallstones / Q000150:complications / Q000000981:diagnostic imaging; D006500:Hepatic Duct, Common / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography