Abstract
A 64-year-old woman who had been treated in a hospital with the diagnosis of cholelithiasis with acute cholecystitis was seen at our hospital after the treatment for the purpose of cholecystectomy. Abdominal contrast-enhanced CT scan and MRI performed before surgery disclosed a gallstone which had impacted in the head of the gallbladder to compress the posterior segmental branch. Since blood examinations revealed elevations of hepatobiliary enzymes, Mirizzi syndrome was diagnosed. Endoscopic retrograde cholangiopancreatography (ERCP) for close exploration revealed fistula formation at the gallbladder and the posterior segmental branch. Preoperative placement of an ENBD tube enabled us to see the fistula directly and to perform surgery safely. The fistula was closed by suture using a part of the gallbladder wall. No postoperative infectious signs occurred and her postoperative course was uneventful.
Cholangiography is essential before surgery for Mirizzi syndrome. So far no reports on fistula formation at the gallbladder and the posterior segmental branch have been presented in the web Japan Medical Abstracts Society as far as we could review. In this case our device in that the fistula is closed with sutures by using the gallbladder wall was necessary.
