title: A rare case of Mirizzi syndrome due to pure calcium carbonate stones (Limy Bile).
abstract: We report the first case of Mirizzi syndrome in a patient who presented with biliary obstruction caused by pure calcium carbonate stones. A 61 years old male with history of portal vein thrombosis presented with rash, nausea and jaundice. An ultrasound of biliary tree showed gallstones with dilatation of hepatic duct and intrahepatic biliary tree. There was suspicion of a stone in proximal CBD. CT scan showed an opaque gallbladder with dense radio-opaque material in its lumen. An ERCP was then performed revealing external common hepatic duct obstruction at the neck of the gallbladder. A plastic biliary stent was placed across the obstruction, followed by a cholecystectomy. Resected gallbladder specimen revealed thick whitish paste like material, and formed stones filling the gallbladder lumen. Laboratory testing showed this material to be composed of 100% calcium carbonate crystals.
authors.affiliation: South Medical Ward, Mayo Hospital/King Edward Medical University, Lahore, Pakistan.
authors.forename: Nooman
authors.initials: N
authors.lastname: Gilani
authors.affiliation: South Medical Ward, Mayo Hospital/King Edward Medical University, Lahore, Pakistan.
authors.forename: Muhammad Farooq
authors.initials: MF
authors.lastname: Hanif
authors.affiliation: Department of Gastroenterology and Hepatology, Phoenix VA Healthcare System/University of Arizona, Phoenix, AZ, USA.
authors.forename: Veronika
authors.initials: V
authors.lastname: Karasek
mesh_terms: D001646:Bile; D002119:Calcium Carbonate; D002760:Cholangiopancreatography, Endoscopic Retrograde; D002763:Cholecystectomy; D042882:Gallstones / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D057792:Mirizzi Syndrome / Q000209:etiology*
chemical_list: D002119:Calcium Carbonate
keywords: Limy bile syndrome, Merrizi syndrome, Bile duct obstruction.