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      Mirizzi syndrome associated with hepatic artery pseudoaneurysm: a case report

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          Abstract

          Introduction

          This is the first case report of Mirizzi syndrome associated with hepatic artery pseudoaneurysm.

          Case presentation

          A 54-year-old man presented with painful obstructive jaundice and weight loss. Computed tomography showed a hilar mass in the liver. Following an episode of haemobilia, angiography demonstrated a pseudoaneurysm of a branch of the right hepatic artery that was embolised. At surgery, a gallstone causing Mirizzi type II syndrome was found to be responsible for the biliary obstruction and a necrotic inflammatory mass and haematoma were found to be extending into the liver. The mass was debrided and drained, the obstructing stones removed and the bile duct drained with a t-tube. The patient made a full recovery.

          Conclusion

          This case highlights another situation where there may be difficulty in differentiating Mirizzi syndrome from biliary tract cancer.

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          Most cited references9

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          Mirizzi syndrome: history, present and future development.

          Joseph Lau, Eric Lai (2006)
          Mirizzi syndrome was reported in 0.3-3% of patients undergoing cholecystectomy. The distortion of anatomy and the presence of cholecystocholedochal fistula increase the risk of bile duct injury during cholecystectomy. A Medline search was undertaken to identify articles that were published from 1974 to 2004. Additional papers were identified by a manual search of the references from the key articles. A preoperative diagnosis was made in 8-62.5% of cases. Open surgical treatment gave good short-term and long-term results. There was a lack of good data in laparoscopic treatment. Conversion to open surgery rates was high, and bile duct injury rate varied from 0 to 22.2%. A high index of clinical suspicion is required to make a preoperative or intraoperative diagnosis, which leads to good surgical planning to treat the condition. Open surgery is the gold standard. Mirizzi syndrome should still be considered as a contraindication for laparoscopic surgery.
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            Hepatic artery pseudoaneurysm: a report of seven cases and a review of the literature.

            David Finley, D. Imagawa, M Belén Hinojosa … (2004)
            To analyze seven cases of hepatic artery pseudoaneurysm (HAP) encountered at our hospital and review the relevant literature. We searched the computerized medical record database from January 1, 1996, to September 1, 2003, to identify all cases of HAP, which we then reviewed in detail, examining etiology, findings, laboratory data, therapeutic intervention, complications, and outcome. We then compared these findings with those reported in the literature. There were five cases of HAP among 18,015 trauma and surgical admissions to the University of California Irvine Medical Center, representing an incidence of 0.03%. There were an additional two cases of HAP among 200 orthotopic liver transplants (OLT). The five HAPs not associated with OLT were preceded by blunt abdominal trauma, liver biopsy, pancreatic pseudocyst, and polyarteritis nodosa, in one patient each, and there was no apparent cause in one patient. Two patients were treated by ligation, and the patients with post-OLT HAP underwent resection and replacement with saphenous bypass grafts. Successful embolization was performed in the other three patients. Hepatic artery pseudoaneurysm is a rare but dangerous complication of both acute surgical and chronic injury to the hepatic artery. However, early diagnosis and intervention can result in an excellent long-term outcome.
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              Hemobilia--evolution of current diagnosis and treatment.

              Markus P. Schneider, W Merrell (1991)
              "Hemobilia," upper gastrointestinal tract bleeding that originates from within the biliary tract, has become widely recognized due to an increased clinical awareness of the disorder and to improvements in diagnostic techniques. In addition, the growing use of percutaneous liver puncture for the diagnosis of and therapy for hepatobiliary diseases and the increased incidence of both blunt and penetrating hepatic trauma have contributed to a rising incidence of hemobilia. We review the history, pathophysiology, and current approaches to the diagnosis and treatment of this disease.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Med Case Reports
                Title: Journal of Medical Case Reports
                Publisher: BioMed Central
                ISSN (Electronic): 1752-1947
                Publication date Collection: 2008
                Publication date (Electronic): 17 November 2008
                Volume: 2
                Page: 351
                Affiliations
                [1 ]Royal Free Hospital & University College School of Medicine, University College London, London, UK
                Article
                Publisher ID: 1752-1947-2-351
                DOI: 10.1186/1752-1947-2-351
                PMC ID: 2600648
                PubMed ID: 19014690
                SO-VID: f76e7f55-b132-4d63-a36e-84f67db915c7
                Copyright © Copyright © 2008 Anderson et al; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 4 September 2007
                Date accepted : 17 November 2008
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Medicine
                Data availability:
                ScienceOpen disciplines: Medicine

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