Korean Journal of Gastrointestinal Endoscopy 1997;17(3): 437-442.
증례 : 담도 췌장 ; 담낭-담관 누공을 동반한 Mirizzi 증후군 1예 ( Case Reports : Biliary Tract & Pancreas ; A Case of Mirizzi Syndrome with Choecystocholedochal Fistula )
장린, 장영운, 이정일, 김병호, 김효종, 동석호, 김경진, 박현주, 김우식 (Rin Chang, Young Woon Chang, Jung Il Lee, Byung Ho Kim, Hyo Jong Kim, Seok Ho Dong, Kyeong Jin Kim, Hyun Ju Park and Woo Sik Kim)
Abstract
The Mirizzi syndrome, obstructive jaundice due to inflammatory or direct compression of common duct is an uncommon complication of longstanding cholecystitis, caused by a cystic duct stone or impacted stone of gallbladder neck. Mirizzi syndrome with resulting repeated attack of inflammation and pressure necrosis leads to the formation of cholecy- stocholedochal fistulas, rarely(Mirizzi syndrome type II), The cholecystocholedochal fistula is very difficult to recognize on preoperative state, and constitute a high risk of damage to the common duct during a cholecystectomy, Since jaundice is the main problem, abdominal sonography and following ERCP(Endoscopic retrograde cholangiopan-creatography) are the primary radiologic tests. But. these findings are so non-specific that exact diagnosis is made in operation room, frequently. We experienced a 67-year-old male patient who complained repeated right upper quadrant pain. On his sonography, dilatation of intrahepatic and common hepatic duct showed and stone was likely to place in the proximal common duct, but gallbladder and cystic duct was not visualized. In operation the gallbladder was identified likely to diverticulum on the common duct and large fistula was present between them. Partial cholecystectomy and Roux-en Y choledochojejunostomy was done. The patient fell in sepsis and discharged hopelessly. (Korean J Gastrointest Endosc 17: 437-442, 1997)