A case of Mirizzi syndrome (common hepato-cholecystic fistula) involving the aberrant B6

Abstract

A 72-year-old man was admitted to our hospital with a diagnosis of septic shock due to acute cholangitis. Computed tomography (CT) suggested cholangitis due to a calculus measuring 20mm lodged at the height of the confluence of the cystic, common hepatic, and common bile ducts. Based on ERCP, MRCP, and DIC-CT findings, Mirizzi syndrome with common hepato-cholecystic fistula was suspected. An ERBD tube was placed in B2, and the cholangitis was relieved with antibiotics and vasopressors. The patient had undergone conservative treatment for cholangitis due to common bile duct stones 8 years prior, and ERCP at the time showed an exceptional aberrant B6, but the MRCP and DIC-CT in this round of treatment did not reveal the B6 branch, suggesting that this site may also be involved in the fistula. Based on the above findings, we decided to perform an open partial cholecystectomy to securely preserve the B6. The postoperative course was uneventful with no stenosis in the bile duct.