SHM Converge Scientific Abstract ePoster Gallery-Cholelithiasis Complicated by Mirizzi Syndrome and Gallbladder Perforation

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Mirizzi syndrome is a rare complication of cholelithiasis, occurring in only about 0.1% of cases. It is caused by an impacted gallstone in the gallbladder neck or cystic duct that compresses the common hepatic duct or common bile duct, leading to obstruction and inflammation. Because persistent pressure and infection can cause serious complications such as fistula, gallbladder perforation, cholangitis, and sepsis, early recognition is important.<br /><br />This report describes a 79-year-old man with a long history of gallstones who presented with right upper quadrant pain, jaundice, leukocytosis, and abnormal liver tests. CT imaging showed acute cholecystitis with an obstructing stone in the gallbladder neck, and ultrasound suggested a possible contained gallbladder perforation. Blood and biliary cultures grew Klebsiella oxytoca. He was initially treated with antibiotics and a cholecystostomy tube.<br /><br />Although cholestatic labs improved, hepatocellular enzymes continued to rise after tube placement, raising concern for Mirizzi syndrome. He then underwent ERCP, which showed dilated bile ducts, and the stone was removed with biliary stent placement. His condition improved, and follow-up imaging three months later showed resolution of inflammation, allowing definitive cholecystectomy.<br /><br />The authors note that only a few similar cases have been reported, most presenting with right upper quadrant pain and fever. This case is notable because Mirizzi syndrome was suspected after rising hepatocellular markers following cholecystostomy, enabling timely ERCP management. The report emphasizes that in patients treated for acute cholecystitis with a cholecystostomy tube, a subsequent rise in liver enzymes should prompt consideration of Mirizzi syndrome to prevent life-threatening complications.

Asset Subtitle

Bibek Saha

Meta Tag

Author List Anjul Verma, Bibek Saha, Victoria Kalinoski-DuBose, William Mundell

Category Clinical Vignettes

Concept Mirizzi Syndrome

Concept Common Hepatic Duct

Concept Common Bile Duct

Concept Impact Gallstone

Concept Right Upper Quadrant Pain

Distinguished Non-Finalist

Presenter Organization Mayo Clinic Rochester, MN

Presenting Author Bibek Saha

Track Adult

Keywords

Mirizzi syndrome

cholelithiasis

gallstone obstruction

acute cholecystitis

common bile duct

right upper quadrant pain

jaundice

ERCP

cholecystostomy tube

biliary stent

Mirizzi Syndrome

Common Hepatic Duct

Common Bile Duct

Impact Gallstone

Right Upper Quadrant Pain