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  • Title: Mirizzi syndrome with cholecysto-choledocal fistula with a high CA19-9 level mimicking biliary malignancies: a case report.
    Author: Principe A, Del Gaudio M, Grazi GL, Paolucci U, Cavallari A.
    Journal: Hepatogastroenterology; 2003; 50(53):1259-62. PubMed ID: 14571713.
    Abstract:
    Mirizzi syndrome type II is a form of obstructive jaundice caused by a stone impacted in the gallbladder neck or the cystic duct that impinges on the common hepatic duct with a cholecysto-choledochal fistula. Preoperative recognition is necessary to prevent injury to the common duct during surgery. We present a patient with an operative diagnosis of type II Mirizzi syndrome, which was not originally indicated in the preoperative work-up; in particular endoscopic retrograde cholangiopancreatography showed stenosis of the middle third of the hepatic duct along with markedly elevated serum CA19-9 levels (up to 35,000 U/mL). Surgical specimen examination did not reveal the presence of neoplasia. We performed cholecystectomy and a jejunal loop was brought up and anastomosed to the common duct at the hilar level in a Roux-en-Y fashion. In cases such as ours with extensive fibrosis and inflamed tissue mimicking cholangiocarcinoma or gallbladder carcinoma, a wide hepaticojejunostomy is required to establish adequate biliary drainage.
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