Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA.
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Kirk Kerkorian School of Medicine at University of Nevada Las Vegas, Las Vegas, NV, USA.
Am J Case Rep. 2022 Aug 14;23:e936836. doi: 10.12659/AJCR.936836.
BACKGROUND Isolated painless jaundice is an uncommon presenting sign for Mirizzi syndrome, which is typically characterized by symptoms of acute or chronic cholecystitis. We report a rare case of Mirizzi syndrome with an acute onset of painless obstructive jaundice. CASE REPORT A 60-year-old man with an unremarkable prior medical history presented with 1 week of jaundice, dark urine, and acholic stools. His laboratory studies revealed a pattern of cholestasis with marked direct hyperbilirubinemia. Ultrasound and magnetic resonance imaging studies demonstrated intrahepatic ductal dilation and cholelithiasis, including a stone within the cystic duct. Endoscopic retrograde cholangiopancreatography with SpyGlass cholangioscopy confirmed the diagnosis of Mirizzi syndrome. CONCLUSIONS An atypical presentation of Mirizzi syndrome should be suspected in the setting of biliary obstruction without pain. The differential diagnosis is broad and includes choledocholithiasis, ascending cholangitis, and hepatobiliary malignancy. Evaluation should include laboratory studies and biliary tract imaging. Noninvasive biliary tract imaging can help exclude malignancy and confirm ductal dilation but is not sensitive for Mirizzi syndrome. Endoscopic retrograde cholangiopancreatography can serve both diagnostic as well as therapeutic purposes via stone extraction and stent placement. SpyGlass cholangioscopy can also augment management in the form of Electrohydraulic lithotripsy. Although therapeutic biliary endoscopy can be very effective, cholecystectomy remains the definitive treatment for Mirizzi syndrome.
孤立性无痛性黄疸是胆系肌症的一种不常见的表现，其典型特征为急性或慢性胆囊炎的症状。我们报告了一例罕见的胆系肌症病例，其表现为急性无痛性梗阻性黄疸。
一位 60 岁男性，既往病史无特殊，因黄疸、浓茶色尿和陶土样便就诊，病程 1 周。实验室研究显示胆汁淤积表现，直接胆红素显著升高。超声和磁共振成像研究显示肝内胆管扩张和胆石症，包括胆囊管内的结石。经内镜逆行胰胆管造影术联合SpyGlass 胆管镜检查确诊为胆系肌症。
在无疼痛的胆道梗阻情况下，应怀疑胆系肌症的非典型表现。鉴别诊断广泛，包括胆总管结石、上行性胆管炎和肝胆恶性肿瘤。评估应包括实验室检查和胆道成像。非侵入性胆道成像有助于排除恶性肿瘤并确认胆管扩张，但对胆系肌症不敏感。内镜逆行胰胆管造影术可通过取石和支架置入进行诊断和治疗。SpyGlass 胆管镜还可通过电液压碎石术辅助治疗。虽然治疗性胆道内镜非常有效，但胆囊切除术仍是胆系肌症的明确治疗方法。
