Mirizzi Syndrome Type IV: diagnosis and management through retrograde endoscopic cholangiopancreatography. Case report

Abstract

The Mirizzi syndrome is a cholelithiasis rare complication, characterized by the mechanical obstruction of the hepato choledocus duct by a calculus impacted in the cystic or in the vesicular neck. We presented a case with cholelithiasis antecedents entering the hospital with a clinical picture compatible with acute cholangitis.  We made an elective cholangiopancreatography finding a big protraction of the intrahepatic biliary tracts, stretch of the supraduodenal choledoc with  a common cystic-vesicular neck and choledocian environment, forming a great duct of near 20 mm diameter, having inside an ovoid filling mistake which bigger diameter is 15 mm, directed  to the choledocus and to the vesicle. We diagnosed a Mirizzi syndrome Type IV. In a patient with those characteristics, the cholangiopancreatography is an unavoidable diagnostic and therapeutic method.