Biliary Ileus as a Manifestation of Type V Mirizzi Syndrome: A Case Report
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Abstract
Introduction:Mirizzi syndrome is defined as extrinsic compression of the common bile duct or common hepatic duct caused by various conditions, most commonly gallstones impacted in the gallbladder neck or cystic duct, as well as inflammatory processes such as chronic cholecystitis or biliary tract neoplasms (1). External compression may lead to erosion, fibrosis, or fistula formation. It is an uncommon condition, occurring in approximately 0.1% of patients with cholelithiasis (2). Type V Mirizzi syndrome, characterized by the presence of a cholecystoenteric fistula, represents one of the rarest and most complex variants. The most frequent fistula is cholecystocolonic, whereas cholecystogastric fistula is the least common. Between 5% and 28% of patients with this condition develop gallbladder carcinoma following cholecystectomy (3).
Case Presentation: We describe the case of a 64-year-old male with a history of untreated type 2 diabetes mellitus who presented to the emergency department with severe abdominal pain, one month of obstructive jaundice, and signs of acute abdomen. Laboratory studies revealed cholestasis and leukocytosis. Prior endoscopic management was non-therapeutic, and imaging studies suggested Type V Mirizzi syndrome. During exploratory laparotomy, a large gallstone associated with a cholecystogastric fistula was identified. Subtotal cholecystectomy and gastric repair with an omental patch were performed. The postoperative course was favorable.
Discussion: Preoperative diagnosis of Mirizzi syndrome remains challenging, particularly in advanced variants. In the presence of hostile anatomy and cholecystoenteric fistulas, subtotal cholecystectomy represents a safe alternative to reduce the risk of bile duct injury.
Conclusion: Type V Mirizzi syndrome requires a high index of suspicion and an individualized surgical approach. Subtotal cholecystectomy is an effective and safe option in complex cases, with favorable clinical outcomes.
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