45 year old female presented with pain abdomen and fever with jaundice Clinically icteric with tenderness right hypochondrium Mrcp given Next?

1 Like

LikeAnswersShare

Symptoms of pain abdomen, jaundice and fever constitutes charcot's triad indicative of CHOLANGITIS. MRCP is indicative of a large calculus impacted in Hartmann's pouch causing compression of CBD and has caused necrosis of gall wall with fistula formation with CHD and as fistula is more than 66 % diameter of CHD - it is MIRRIZI SYNDROME TYPE 4 . Start with parenteral antibiotics 3rd generation cephalosporins and ERCP stenting. Once jaundice and cholangitis settles. Definitive surgery of cholecystectomy and fistula closure over a T- tube can be done

I agree
0

- multiple CHOLIDOCHOLITHIASIS in CBD - resultant obstructive jaundice. - ERCP need to be done ASAP - impacted cholidothiasis should be treated with removal of stone with stenting- T tube application may needed SOS Hepaticojejunistomy- decision may need to take during procedure immediately if chances of stenting/ T- tube application failure as per clinical condition.

Multiple CBD calculi with Mirrizi's syndrome ERCP + extraction of stone + stenting Elective surgery once patient stable and jaundice normalised Considering the size of stone, there is a possibility that CBD may not be possible to reconstruct intraoperatively Therefore, this patient may require hepaticojejunostomy

I agree
1

Mirrizi syndrome type 4 in cholangitis. ICU or HDU admission.... IV antibiotics and resuscitation Prepare for earliest possible ERC stenting. Definite Sx later electively.

I agree
0

Large multiple difficult CBD stones with mirrizis Ideally ERCP with stenting can be tried But definitive would be surgical exploration

I agree
0

Dilatation of CBD obs5ructive jaundice . GB stone with cholecystitis if present. is stable cholecystectomy.

Dilatation of cbd obstrutive jaundice GB stone with cholecystitis if pt is stable cholecystectomy .

Valuable opinion
0

Multiple CBD calculi causing dialation of biliary radicals.

Multiple CBD calculi with Mirrizi syndrome.

I agree
0

Choledocholithiasis. Do ERCP.

Load more answers

Cases that would interest you