SHM Converge Scientific Abstract ePoster Gallery-Post-Surgical Antibiotics in Acute Cholecystitis Complicated by Mirrizi Syndrome

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This case report describes a 62-year-old woman with acute calculous cholecystitis complicated by Mirizzi syndrome, a rare condition in which an impacted gallstone compresses the common hepatic duct. She presented with two weeks of right upper quadrant pain radiating to the back, along with nausea, vomiting, and subjective fever. Exam showed right upper quadrant tenderness and a positive Murphy’s sign. Labs were largely normal, but ultrasound revealed gallbladder wall thickening, pericholecystic fluid, cholelithiasis, and a fixed stone in the gallbladder neck. MRCP confirmed a large gallstone at the gallbladder neck causing mild biliary duct compression and ductal prominence.<br /><br />She was treated initially with Zosyn after blood cultures were obtained. Laparoscopic cholecystectomy was performed on hospital day 4. Antibiotics were continued for only 24 hours after surgery, and she was discharged two days later without complications.<br /><br />The discussion highlights that, according to the 2018 Tokyo Guidelines, most cases of acute cholecystitis are mild to moderate, and evidence suggests prolonged postoperative antibiotics do not improve outcomes in Grade I or II calculous cholecystitis. Avoiding unnecessary antibiotics is important because overuse contributes to multidrug-resistant bacteria and increases adverse effects.<br /><br />Overall, the case supports limited postoperative antibiotic use after cholecystectomy in uncomplicated mild-to-moderate acute cholecystitis, even when Mirizzi syndrome is present, as long as the patient has an uncomplicated surgical course.

Asset Subtitle

Merelyn Thomas

Meta Tag

Author List Bruno Álvarez Concejo, Merelyn Thomas

Category Clinical Vignettes

Concept Mirizzi Syndrome

Concept Gallstone

Concept Acute Calculous Cholecystitis

Concept Common Hepatic Duct

Concept Cystic Duct

Distinguished Non-Finalist

Presenter Organization LSU Health Shreveport

Presenting Author Merelyn Thomas

Track Adult

Keywords

acute calculous cholecystitis

Mirizzi syndrome

gallstone

laparoscopic cholecystectomy

right upper quadrant pain

biliary duct compression

Tokyo Guidelines

postoperative antibiotics

ultrasound

MRCP

Mirizzi Syndrome

Gallstone

Acute Calculous Cholecystitis

Common Hepatic Duct

Cystic Duct