Abstract
We report a case intraoperatively diagnosed as Mirizzi syndrome that was actually gallbladder cancer according to postoperative pathology. A 68–year–old woman admitted elsewhere for cerebral infarction and showing increased hepatobiliary enzyme in blood tests was found in imaging to have a 10–cm–plus gallbladder stone, common–hepatic–duct stenosis, and a dilated intrahepatic bile duct, necessitating surgery based on a diagnosis of Mirizzi syndrome. Intraoperatively Calot′s triangle was difficult to mobilize due to severe inflammation, so the gallbladder fundus was partially resected and the gallbladder stone removed. Upon examining the lumen of the gallbladder, we found a preoperatively placed endoscopic biliary drainage (EBD) tube, yielding a diagnosis of fistula between the gallbladder and common hepatic duct. No malignant pathological findings were observed intraoperatively. Cholecystotomy, T–tube placement, and suture repair of the gallbladder were then done. The definitive pathological diagnosis, however, was tubular carcinoma. Given the woman′s general condition, we decided against more resection and are following her up on an ambulatory basis.
