Presentation
Abdominal pain and jaundice.
Patient Data
The intrahepatic biliary ducts are moderately dilated (left hepatic duct > right hepatic duct).
The common bile duct (CBD) is normal in calibre and has homogeneous intraluminal signal intensity. Sludge is seen within the fundus and neck of the gall bladder.
Impression: large calculus at the neck of the gall bladder severely compressing the common hepatic duct and resulting in dilatation of intrahepatic biliary ducts - Mirizzi syndrome type I.
The scout view shows a radio-opaque shadow in the right hypochondriac region.
Round hyperdense calculus is seen within the neck of the gall bladder which is compressing the common hepatic duct.
Case Discussion
Mirizzi syndrome is a rare condition which is caused by extrinsic compression over the extrahepatic biliary duct from stone within the cystic duct or gall bladder neck. It causes obstructive jaundice. Fistula can develop between gall bladder and common bile duct. Gallstone ileus may also develop if the stone passes into small bowel through a cholecysto-enteric fistula.
Co-author- Dr. Shafayat Muhammed Shantonu (MD- hepatobiliary surgery)