Concluded Case

Mirizzi syndrome with obstructive Jaundice

A female patient aged 60 yrs presented with Pain upper mid abdomen for 12days Nausea with vomiting for 12 days High coloured urine for 10 days Itching of body for 07 days P/H nothing relevant O/E Conscious and alert , Afebrile, normotensive Icterus ++ Abd Soft No Lump Bowel sounds present Chest clear CVS clinically nad Provisional diagnosis Obstructive Jaundice Investigations reports attached Consulted a Gastroenterologist Underwent ERCP stone could not be retrieved hence only stenting done PATIENT CONSULTED ME Advised MRCP Report attached suggestive of MIRIZZI SYNDROME NO BILIART STENT Kindly suggest management

(Edited)

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Concluded answer

Final diagnosis Mirizzi Type 2 Syndrome MRI and MRCP both were done. Planned Subtotal cholecystectomy with Roux en Y Hepaticojejunostomy . Referred to Higher center for needful

All Answers

Ideally in an elderly female presenting with painful OJ, any underlying malignancy should be ruled out. MRCP shows only the level of obstruction but the cause of obstruction cannot be evaluated by MRCP. So, was a MRI also done along with MRCP. If MRCP shows no other etiology except for the stone then the patient should undergo surgery. But the decision regarding the type of surgery will depend on the type of Mirizzi syndrome as presence of cholecystobiliary fistula will require either choledochoplasty or bilioenteric anastomosis.

Thank you doctor
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NEED'S .. HPE STUDY .. AND .. MRI STUDY.. TO R/O MALIGNANCY.. EXPERTS OPINION..

Thank you doctor
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Final diagnosis Mirizzi Type 2 Syndrome MRI and MRCP both were done. Planned Subtotal cholecystectomy with Roux en Y Hepaticojejunostomy . Referred to Higher center for needful

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