Franceschi Paola, Brandi Nicolò, Pecorelli Anna, Vitale Giovanni, Cescon Matteo, Renzulli Matteo
Department of Radiology, IRCSS Azienda Ospedaliero Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy.
Unit of Internal Medicine for the Treatment of Severe Organ Failure, Surgical Department of Digestive, Hepatic and Endocrine-Metabolic Diseases, IRCSS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy.
Radiol Case Rep. 2023 Sep 14;18(11):4157-4159. doi: 10.1016/j.radcr.2023.08.077. eCollection 2023 Nov.
A man in his 40s presented to our Hospital with abdominal pain, jaundice, and pruritus. He had a history of Alagille Syndrome treated with cholecystojejunostomy in the neonatal period because of initial misdiagnosis of biliary atresia. Laboratory investigations showed hyperbilirubinemia (total bilirubin 1.76 mg/dL [<1.2 mg/dL]; conjugated 1.06 mg/dL [<0.3 mg/dL]) and cholestasis (GGT 78 U/L [<50 U/L]; ALP 200 U/L [<50 U/L]). Transabdominal ultrasound was limited by aerobilia due to the cholecystojejuno-anastomosis. Subsequent basal CT scan revealed an impacted stone within the patient's native common bile duct (CBD). Aerobilia in intrahepatic bile ducts and gallbladder was reported. Magnetic Resonance cholangiopancreatography confirmed the gallstone in the CBD compressing cystic duct and common hepatic duct, with dilation of the upstream bile ducts. Furthermore, the native CBD was obstructed by other gallstones. In Mirizzi syndrome, gallstones impacted in gallbladder's Hartmann's pouch or cystic duct extrinsically compress CBD. We suggest naming the present condition "Reverse Mirizzi Syndrome" (Renzulli Matteo Syndrome, RMS) because it is the exact opposite of Mirizzi syndrome.
一名40多岁男性因腹痛、黄疸和瘙痒前来我院就诊。他有阿拉吉耶综合征病史，新生儿期因最初误诊为胆道闭锁而接受了胆囊空肠吻合术治疗。实验室检查显示高胆红素血症（总胆红素1.76mg/dL[<1.2mg/dL]；结合胆红素1.06mg/dL[<0.3mg/dL]）和胆汁淤积（γ-谷氨酰转移酶78U/L[<50U/L]；碱性磷酸酶200U/L[<50U/L]）。经腹超声因胆囊空肠吻合术导致的积气而受限。随后的基础CT扫描显示患者的胆总管内有一枚嵌顿结石。报告了肝内胆管和胆囊内的积气情况。磁共振胰胆管造影证实胆总管内的胆结石压迫胆囊管和肝总管，上游胆管扩张。此外，胆总管被其他胆结石阻塞。在Mirizzi综合征中，胆囊颈部或胆囊管内的胆结石会外在压迫胆总管。我们建议将目前这种情况命名为“反向Mirizzi综合征”（伦祖利·马泰奥综合征，RMS），因为它与Mirizzi综合征正好相反。
