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Case Reports
. 2022 Aug 14:23:e936836.
doi: 10.12659/AJCR.936836.

Unusual Case of Mirizzi Syndrome Presenting as Painless Jaundice

Justin Bauzon  1 , Sarah Haller  1 , Jose R Aponte-Pieras  2 , Daisy Lankarani  2 , Ariyon Schreiber  3 , Nazanin Houshmand  3 , Shahid Wahid  2
Affiliations
Case Reports

Unusual Case of Mirizzi Syndrome Presenting as Painless Jaundice

Justin Bauzon et al. Am J Case Rep. .

Abstract

BACKGROUND Isolated painless jaundice is an uncommon presenting sign for Mirizzi syndrome, which is typically characterized by symptoms of acute or chronic cholecystitis. We report a rare case of Mirizzi syndrome with an acute onset of painless obstructive jaundice. CASE REPORT A 60-year-old man with an unremarkable prior medical history presented with 1 week of jaundice, dark urine, and acholic stools. His laboratory studies revealed a pattern of cholestasis with marked direct hyperbilirubinemia. Ultrasound and magnetic resonance imaging studies demonstrated intrahepatic ductal dilation and cholelithiasis, including a stone within the cystic duct. Endoscopic retrograde cholangiopancreatography with SpyGlass cholangioscopy confirmed the diagnosis of Mirizzi syndrome. CONCLUSIONS An atypical presentation of Mirizzi syndrome should be suspected in the setting of biliary obstruction without pain. The differential diagnosis is broad and includes choledocholithiasis, ascending cholangitis, and hepatobiliary malignancy. Evaluation should include laboratory studies and biliary tract imaging. Noninvasive biliary tract imaging can help exclude malignancy and confirm ductal dilation but is not sensitive for Mirizzi syndrome. Endoscopic retrograde cholangiopancreatography can serve both diagnostic as well as therapeutic purposes via stone extraction and stent placement. SpyGlass cholangioscopy can also augment management in the form of Electrohydraulic lithotripsy. Although therapeutic biliary endoscopy can be very effective, cholecystectomy remains the definitive treatment for Mirizzi syndrome.

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Conflict of interest statement

Conflict of interest: None declared

Figures

Figure 1.
Figure 1.
Magnetic resonance cholangiopancreatographic (A) axial and (B) coronal imaging illustrating intrahepatic ductal dilatation (red arrows).
Figure 2.
Figure 2.
Endoscopic retrograde cholangiopancreatography demonstrating (A) common bile duct obstruction (red arrow) and (B) dilatation within the intrahepatic ducts (red arrows).
Figure 3.
Figure 3.
Endoscopic images demonstrating stent placement and the resultant bile flow.
Figure 4.
Figure 4.
Intraoperative image of the cholangioscope being advanced through the common bile duct to the intrahepatic duct bifurcation.
See this image and copyright information in PMC

References

    1. Jones MW, Ferguson T. StatPearls [Internet] Treasure Island (FL): StatPearls Publishing; 2021. Jan, Mirizzi syndrome. 2021 Feb 8. - PubMed
    1. Valderrama-Treviño AI, Granados-Romero JJ, Espejel-Deloiza M, et al. Updates in Mirizzi syndrome. Hepatobiliary Surg Nutr. 2017;6(3):170–78. - PMC - PubMed
    1. Baer HU, Matthews JB, Schweizer WP, et al. Management of the Mirizzi syndrome and the surgical implications of cholecystcholedochal fistula. Br J Surg. 1990;77(7):743–45. - PubMed
    1. Gomez D, Rahman SH, Toogood GJ, et al. Mirizzi’s syndrome – results from a large western experience. HPB (Oxford) 2006;8(6):474–79. - PMC - PubMed
    1. Beltran MA, Csendes A, Cruces KS. The relationship of Mirizzi syndrome and cholecystoenteric fistula: Validation of a modified classification. World J Surg. 2008;32(10):2237–43. - PubMed

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