Cholecystocolonic fistula: A rare case report of Mirizzi syndrome. (2019)

• Record Type: Journal Article
• Authors: Esparza Monzavi, C.A.; Peters, X.; Spaggiari, M.
• Is Part Of: International journal of surgery case reports. Volume 63(2019)
• Page Start: 97
• Page End: 100
• Publication Date: 2019
• Subjects: Case report -- Mirizzi syndrome -- Cholecystocolonic fistula -- Cholecystoenteric fistula; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2019.09.023
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Mirzzi syndrome is a rare complication of gallstone disease that involves compression on the biliary tree by a stone within the gallbladder. Rarely, in advanced disease Mirizzi syndrome may present with concurrent choleystoenteric fistula. Cholecystocolonic fistula are rare in the setting of Mirizzi syndrome. In Mirizzi syndrome with cholecystocolonic fistula, possible malignancy in the setting of severe inflammation must be considered. Abstract: Introduction: Mirizzi syndrome is a rare complication of gallstone disease that more rarely is associated with the formation of cholecystoenteric fistula. Presentation of case: The patient presented with a five-day history of abdominal pain in the right upper quadrant (RUQ), nausea, and emesis. Further ultrasound (US) imaging demonstrated a large gallstone with associated thickened gallbladder with pericholecystic fluid. Computed tomography (CT) imaging, preoperative Hepatobiliary Scintigraphy and Endoscopic Retrograde Cholangiopancreatography (ERCP) displayed findings consistent with a Csendes type IV Mirizzi syndrome associated with cholecystocolonic fistula. Description of surgical approach, management and outcome is presented. Discussion: Surgical management of Mirizzi syndrome varies by classification of its severity. Open operation is preferred in cases with severe inflammation and concern for malignancy. The patient underwent a cholecystocolonic fistula takedown. A cholecystectomy was attempted though aborted due to concerns of malignancy. Biopsies returned negative for malignancy and the patient demonstrated findings on ERCP consistent with Mirizzi syndrome. Stenting of the common bile duct (CBD) was performed with ERCP and later the patient underwent an open biliary exploration with subsequent choledochotomy, biliary stone removal, and primary closure with interrupted sutures using remnant gallbladder wall flaps. Conclusion: To our knowledge, Mirizzi syndrome with concurrent cholecystocolonic fistula is exceedingly rare with a paucity of reports within the literature. Our report discusses principles of management of Mirizzi syndrome as well as best practices of surgical management for Mirizzi syndrome with concurrent cholecystocolonic fistula.