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Abstract
ABSTRACT
Objective: This case report presents the diagnosis and management of Mirizzi syndrome type IV in conjunction with choledocholithiasis. Method: We document the case of an 84-year-old man with right upper quadrant abdominal pain, jaundice, and postprandial distension. Endoscopic retrograde cholangiopancreatography (ERCP) revealed dilation of the common bile duct with a 15 mm filling defect. Endoscopic sphincterotomy was unsuccessful due to a duodenal diverticulum, so a biliary stent was placed. Given the persistence of symptoms and the failure of ERCP, intraoperative findings confirmed a large stone in the distal common bile duct and a cholecystocholedochal fistula, consistent with Mirizzi. Results: Exploratory laparoscopy was performed with conversion to open surgery, creating a Roux-en-Y hepaticojejunostomy and performing and cholecystectomy. The postoperative course was favorable, with biochemical improvement and resolution of symptoms. Discussion: Mirizzi syndrome type IV is a rare condition that continues to present a surgical challenge requiring accurate diagnosis and individualized treatment strategies.
Keywords: Mirizzi, choledocholithiasis, cholestasis, Roux-en-Y.
References
REFERENCIAS
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