A CASE OF MIRIZZI SYNDROME WITH LOW JUNCTION OF THE CYSTIC DUCT

THE USEFULLNESS OF THE GUIDANCE WITH ERBD TUBE DURING CHOLECYSTECTOMY

Abstract

A 54-year-old woman with an one-month history of abdominal full sensation was admitted to the hospital under a diagnosis of gallstone. At first, she was suspected to have common bile duct (CBD) stone because she showed icterus. Endoscopic retrograde cholangiopancreatography (ERCP) showed stenosis of the CBD. However, no stone was found, and then, naso-biliary drainage (NBD) tube was inserted. The findings of the cholangiography through the NBD tube after the improvement of her icterus suggested Mirizzi syndrome. After the exchange of the NBD tube with an endoscopic retrograde biliary drainage (ERBD) tube, a laparotomy was performed. The operative findings showed a 20mm sized pure cholesterol stone fixed in the cystic duct and severe inflammatory adhesions around the cystic duct, reconfirming Mirizzi syndrome. A cholecystectomy and a removal of the fixed stone in the cystic duct were safely performed without injuries to hepatic duct. The ERBD tube was very useful to differentiate these cystic and hepatic ducts in this procesure.