Intermittent episodes of abdominal pain for one month, now with one week of persistent vomiting. Tender RUQ. Markedly deranged LFTs, normal lipase. Previous laparoscopic cholecystectomy.
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Although has there has been prior cholecystectomy, a gallbladder stump persists (as seen on a recent MRCP). There is a partially peripherally calcified 9 mm calculus within the cystic duct which has migrated medially (since the external CT cholangiogram 9 days earlier). The cystic duct calculus is causing extrinsic compression of the common hepatic duct which is dilated measuring 16 mm (previously 8 mm on the CT cholangiogram). No intrahepatic duct dilatation.
Features are therefore in keeping with Mirizzi syndrome.
Incidental circumaortic left renal vein.