Lalountas Miltiadis, Smyrlis Nikolaos, Mouratidis Stylianos Vladimiros, Makedos Panagiotis
Department of Surgery, General Hospital of Polygyros, Chalkidiki, Greece.
, 54249, Thessaloniki, Greece.
Surg Case Rep. 2023 Jun 19;9(1):110. doi: 10.1186/s40792-023-01696-7.
Mirizzi syndrome (MS) is a complicated form of longstanding, symptomatic cholelithiasis. According to Beltran Classification MS Type V has been introduced to describe the cholecystoenteric fistula, with or without gallstone ileus. Mirizzi syndrome Type V with double fistula has been reported in the past; however, the triple fistula is an even rarer case, first described in the international literature so far.
A 77-year-old male was admitted to our surgical department with recurrent episodes of abdominal pain, which initially presented in the last 6 months and was accompanied with jaundice. Computed tomography showed findings of cholelithiasis, pneumobilia and choledocholithiasis. We performed an ERCP, which showed two fistulas of the gallbladder with the pyloric antrum and the duodenum, respectively. Surgical treatment was immediately undergone and during laparotomy, we confirmed these findings. We ligated and dissected these communications. In addition, a third fistula between the gallbladder and the common bile duct was identified. An insertion of a Kehr T-tube into the common bile duct was performed via the gallbladder. After 3 months, the Kehr T-tube was removed and in the subsequent 2 years of follow-up the patient was presented without complications.
Mirizzi syndrome complicated with triple fistula, first described in the international literature, to the best of our knowledge, confirms the long natural history of inflammation.
Mirizzi综合征（MS）是一种长期存在的、有症状的胆石症的复杂形式。根据贝尔特兰分类法，引入了MS V型来描述胆囊肠道瘘，伴或不伴有胆石性肠梗阻。过去曾报道过伴有双瘘的Mirizzi综合征V型；然而，三瘘是一种更为罕见的病例，据我们所知，这是国际文献中首次描述。
一名77岁男性因反复腹痛入院，最初在过去6个月出现，并伴有黄疸。计算机断层扫描显示有胆石症、气肿性胆囊炎和胆总管结石的表现。我们进行了内镜逆行胰胆管造影（ERCP），结果显示胆囊分别与幽门窦和十二指肠有两个瘘管。立即进行了手术治疗，在剖腹手术中，我们证实了这些发现。我们结扎并分离了这些通道。此外，还发现胆囊与胆总管之间有第三个瘘管。通过胆囊将Kehr T形管插入胆总管。3个月后，取出Kehr T形管，在随后的2年随访中，患者未出现并发症。
据我们所知，Mirizzi综合征合并三瘘在国际文献中首次被描述，证实了炎症的漫长自然病程。
