Abstract
A 76-year-old man with jaundice and a one-year history of self-reported epigastralgia was admitted to the hospital. Abdominal CT showed gallstones and dilation of the common hepatic duct and intrahepatic biliary tree. Gallstones were impacted in the neck of the gallbladder and compressed the right wall of the common hepatic duct. Endoscopic retrograde biliary drainage (ERBD) alleviated jaundice, but complicating cholangitis occurred, and ERBD was then replaced by endoscopic nasobiliary drainage (ENBD). In surgery, the gallbladder was opened and the stones impacted in the neck were extracted, confirming a diagnosis of Mirizzi syndrome with cholecystohepaticodochal fistula. Cholecystectomy was performed, and a common hepatic duct defect was covered with a part of the ligamentum teres hepatis, through which a common hepatic duct drainage tube was put in place. On postoperative day 50, the drainage tube was removed. There was no hepatic dysfunction, and the patient was discharged on postoperative day 69. In surgery of Mirizzi syndrome with biliary fistula, it is necessary to choose an appropriate method of biliary drainage based on the intraoperative findings.
