Kolesistektomi sonrasi olusan Mirizzi sendromu olgusu
A case of Mirizzi’s syndrome after cholecystectomy
Özet
Mirizzi sendromu, sistik kanal ya da safra kesesi boynuna impakte tasin, koledok kanalina distan basisi sonucu gelisir. Bu makalede, kolesistektomiden 6 yil sonra gelisen ve tekrarlayan bir Mirizzi sendromu olgusu sunulmustur. 48 yasindaki erkek hastamiz, ates, bulanti, kusma ve sarilik yakinmalari ile klinigimize müracaat etti. Biyokimyasal tetkiklerinde, kolestatik paternde karaciger enzim yüksekligi saptandi. Yapilan ERCP’de, koledogun genis, sistik kanal güdügünün uzun ve distal yerlesimli oldugu görüldü. Sistik kanalda bir adet dolma defekti mevcuttu. Endoskopik sfinkteromi yapilarak, balon yardimiyla sistik kanaldan tas ekstrakte edildi. Islem sonrasinda klinik ve laboratuvar bulgulari hizli bir sekilde normale döndü. 11 ay sonra, hastamizda ayni klinik ve laboratuvar bulgulari tekrar ortaya çikti. Yinelenen ERCP’de, sistik kanal güdügünde tas görüldü ve endoskopik yöntemle çikarildi. 15 aylik takip süresince hasta stabil seyretti. Kolesistektomi sonrasinda gelisen ekstrahepatik kolestaz tablosunda, uzun birakilmis ve distal yerlesimli sistik kanal güdügü bulunanlarda Mirizzi sendromu da tanilar arasinda düsünülmelidir.
Abstract
Mirizzi’s syndrome refers to common bile duct obstruction resulting from compression by a gallstone impacted in the cystic duct or neck of the gallbladder. Herein we report a 48-year-old man with Mirizzi’s syndrome presenting six years after cholecystectomy. The patient applied to our department with complaints of fever, vomiting and jaundice. Liver biochemical tests revealed enzyme elevations in cholestatic pattern. Endoscopic retrograde cholangiopancreatography (ERCP) showed dilatation of the choledochus, and the remnant of the cystic duct was long and distally placed. There was a filling defect in the cystic duct. A stone was removed from the cystic duct via balloon extraction after endoscopic sphincterotomy. The clinical and laboratory findings returned to normal after the procedure. After 11 months, the cholestatic findings reappeared. A stone was detected and removed again in ERCP. The patient has been well at follow-up for 15 months. Mirizzi’s syndrome must be considered in cholecystectomized patients with long and distally placed cystic duct stump if extrahepatic cholestasis is present.
