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    A Case of Obstructive Jaundice: Um Caso de Icterícia Obstrutiva

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    A Case of Obstructive Jaundice: Um Caso de Icterícia Obstrutiva

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    GE Port J Gastroenterol.

    2015;22(1):32---33

    www.elsevier.pt/ge

    IMAGES IN GASTROENTEROLOGY AND HEPATOLOGY

    A Case of Obstructive Jaundice


    Um Caso de Icterícia Obstrutiva
    Nuno Veloso ∗ , Sara Pires, Rogério Godinho

    Gastroenterology Department, Hospital Espírito Santo, Évora, Portugal

    Received 13 September 2013; accepted 24 September 2014


    Available online 14 January 2015

    An 84-year-old woman presented with a 2-day history 893 U/L, gamma-glutamyl transferase 1143 U/L) with ele-
    of jaundice, fever and abdominal pain. Physical exami- vated liver enzymes (aspartate aminotransferase 231 U/L,
    nation showed scleral icterus and right upper quadrant alanine aminotransferase 178 U/L). Abdominal ultrasound
    tenderness without inspiratory arrest at palpation (absent demonstrated a scleroatrophic gallbladder with cholelithi-
    Murphy’s sign). Laboratory workup revealed leukocytosis asis and an impacted large gallstone in the common
    (12.4 × 103 ␮L), elevated C-reactive protein (8.3 mg/dL) bile duct with dilated common and intrahepatic bile
    and cholestasis (bilirubin 5.4 mg/dL, alkaline phosphatase ducts.

    Figure 1 ERCP: cholangiography.

    ∗ Corresponding author.
    E-mail address: nuno veloso@hotmail.com (N. Veloso).

    http://dx.doi.org/10.1016/j.jpge.2014.09.002
    2341-4545/© 2013 Sociedade Portuguesa de Gastrenterologia. Published by Elsevier España, S.L.U. All rights reserved.
    Obstructive Jaundice 33

    in the serum concentrations of alkaline phosphatase and


    bilirubin.2
    The Mirizzi syndrome is part of the differential diag-
    nosis of obstructive jaundice and therefore the diagnostic
    approach usually begins with ultrasonography comple-
    mented by ERCP or magnetic resonance cholangiogra-
    phy.
    A useful classification system takes into account the pres-
    ence and extent of a cholecystobiliary fistula, due to erosion
    of the anterior or lateral wall of the common bile duct by
    impacted stones.3
    Surgery is the mainstay of therapy for Mirizzi syndrome.4
    ERCP treatment can be effective as a temporizing measure
    before surgery and can be definitive treatment for unsuit-
    able surgical candidates.

    Ethical disclosures

    Protection of human and animal subjects. The authors


    declare that no experiments were performed on humans or
    animals for this study.

    Confidentiality of data. The authors declare that they have


    Figure 2 ERCP: internal stenting. followed the protocols of their work center on the publica-
    tion of patient data.

    Right to privacy and informed consent. The authors


    We performed an endoscopic retrograde cholangiopan-
    declare that no patient data appear in this article.
    creatography (ERCP) that clearly showed common hepatic
    duct compression by a large gallstone (20 mm) impacted
    in the cystic duct (Fig. 1), compatible with the diagnosis References
    of Mirizzi syndrome. Successful biliary decompression was
    performed by internal stenting (Fig. 2) with subsequent 1. Alberti-Flor JJ, Iskandarani M, Jeffers L, Schiff ER. Mirizzi syn-
    patient referral to surgery (cholecystectomy plus closure of drome. Am J Gastroenterol. 1985;80:822.
    the fistula). 2. Binmoeller KF, Thonke F, Soehendra N. Endoscopic treatment of
    Mirizzi’s syndrome. Gastrointest Endosc. 1993;39:532.
    The Mirizzi syndrome refers to common hepatic duct
    3. Csendes A, Díaz JC, Burdiles P, Maluenda F, Nava O. Mirizzi syn-
    obstruction caused by an extrinsic compression from an
    drome and cholecystobiliary fistula: a unifying classification. Br
    impacted stone in the cystic duct or Hartmann’s pouch J Surg. 1989;76:1139.
    of the gallbladder.1 The majority of the patients present 4. Kwon AH, Inui H. Preoperative diagnosis and efficacy of laparo-
    the clinical triad of jaundice, fever, and right upper quad- scopic procedures in the treatment of Mirizzi syndrome. J Am
    rant pain, showing in the laboratory evaluation elevations Coll Surg. 2007;204:409.

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