Laparoscopic management of Mirizzi syndrome
Epublication WebSurg.com, Jan 2013;13(01). URL: http://websurg.com/doi/vd01en3852
The surgical management of acute cholecystitis continues to be a matter of personal choice. At our institution, we perform early laparoscopic cholecystectomy electively after treatment with intravenous fluids and antibiotics. We present the case of a 35-year-old man who was admitted with a history of pain in the right upper abdomen for one day. He was managed with analgesics, intravenous fluids, and antibiotics. Despite relief from pain with aggressive medical therapy, he developed jaundice. An ultrasound examination confirmed a small stone impacted in the neck of the gallbladder and non-dilated biliary radicles. In view of increased serum bilirubin, the patient was scheduled for laparoscopic cholecystectomy. Laparoscopic cholecystectomy revealed a gangrenous gallbladder with dilated cystic and common bile ducts. Intraoperative cholangiogram showed a suspicious filling defect at the lower end of the common bile duct. The ureteric catheter was therefore left indwelling and removed after one month.