Clin Endosc > Volume 54(5); 2021 > Article
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Yang and Park: A Stone in Remnant Cystic Duct Causing Mirizzi Syndrome Following Laparoscopic Cholecystectomy

Quiz

A 63-year-old woman was admitted to the hospital with obstructive jaundice. Thirteen years prior, she underwent laparoscopic cholecystectomy for gallstones.
Computed tomography (CT) showed dilatation of the proximal common hepatic duct and intrahepatic duct (Fig. 1A). A round signal void was then observed on magnetic resonance cholangiopancreatography (Fig. 1B).
On endoscopic retrograde cholangiopancreatography (ERCP), the bile duct was cut off at the level of the common hepatic duct; this suggested the presence of 1.5-cm filling lesions that led to the obstruction of the common hepatic duct (Fig. 1C).
Mass-like extrinsic compression in the common hepatic duct and clogging of the cystic duct orifice were observed on endoscopic findings of single-operator peroral cholangioscopy (SOPC) (Fig. 1D). To address the jaundice, a plastic stent was inserted in the intrahepatic bile duct.
What is the most likely diagnosis?
 

NOTES

Conflicts of Interest: The authors have no potential conflicts of interest.
Funding
None

Fig. 1.
(A) Computed tomography scan showed the dilatation of the proximal common hepatic duct and intrahepatic duct. (B) A round signal void was seen on magnetic resonance cholangiopancreatography. (C) The bile duct was cut off at the level of common hepatic duct, suggesting 1.5-cm filling lesions that obstructed the common hepatic duct, as seen on endoscopic retrograde cholangiography. (D) Mass-like extrinsic compression in the common hepatic duct and clogging of the cystic duct orifice was found upon single operator peroral cholangioscopy.
ce-2021-205f1.jpg
Fig. 2.
(A) On follow-up endoscopic retrograde cholangiopancreatography, transpapillary biopsy and balloon dilation for biliary stricture was performed. (B) Numerous cholesterol stones were retrieved via basket extraction. (C) Follow-up computed tomography scan showed no residual stones or mass lesions in the bile duct.
ce-2021-205f2.jpg

REFERENCES

1. Pemberton M, Wells AD. The Mirizzi syndrome. Postgrad Med J 1997;73:487-490.
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2. Chen H, Siwo EA, Khu M, Tian Y. Current trends in the management of Mirizzi syndrome: a review of literature. Medicine (Baltimore) 2018;97:e9691.
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3. Bhandari S, Bathini R, Sharma A, Maydeo A. Usefulness of single-operator cholangioscopy-guided laser lithotripsy in patients with Mirizzi syndrome and cystic duct stones: experience at a tertiary care center. Gastrointest Endosc 2016;84:56-61.
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4. Chon HK, Park C, Kim TH. Minimally invasive approach using digital single-operator peroral cholangioscopy-guided electrohydraulic lithotripsy and endoscopic nasogallbladder drainage for the management of highgrade Mirizzi syndrome. Clin Endosc 2021 Feb 18 [Epub]. https://doi.org/10.5946/ce.2021.015.
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