Department of Gastroenterology, Centre Hospitalier de Wallonie picarde, Tournai, Belgium.
Acta Gastroenterol Belg. 2024 Jul-Sep;87(3):424-426. doi: 10.51821/87.3.12301.
Mirizzi syndrome is a rare complication of chronic gallstone disease characterised by the compression of the common bile duct due to an impacted lithiasis in the infundibulum of the gallbladder or cystic duct. In this case study, we discuss an 85-yearold patient who presented with Mirizzi syndrome associated with septic shock. She was not eligible for cholecystectomy due to her advanced age and frailty, requiring a less invasive alternative. Gallbladder drainage was initiated by endoscopic ultrasoundguided cholecystoduodenostomy with a lumen-apposing metal stent (LAMS). Utilising this bulbo-cholecystic stent, SpyGlassguided electrohydraulic lithotripsy (SGEHL) was then performed, resulting in successful extraction of multiple bile stones, including a 20 mm lithiasis that was lodged in the cystic infundibulum. Subsequently, serum bilirubin levels and inflammatory markers were significantly reduced, consistent with resolution of Mirizzi syndrome. The combination of SGEHL and LAMS, designated as SLAMS, represents a novel, minimally invasive intervention for this potentially life-threatening disease.
Mirizzi 综合征是一种罕见的慢性胆石病并发症，其特征是由于胆囊或胆囊管壶腹内的结石嵌顿导致胆总管受压。在本病例研究中，我们讨论了一位 85 岁的患者，其患有 Mirizzi 综合征并伴有感染性休克。由于年龄较大和身体虚弱，她不符合胆囊切除术的条件，需要选择一种侵入性较小的替代方案。通过内镜超声引导下的胆囊十二指肠吻合术（胆管内支架引流术）和使用腔镜贴合金属支架（LAMS）进行了胆囊引流。然后使用 SpyGlass 引导的电液压碎石术（SGEHL）进行了治疗，成功地取出了多个胆石，包括一个 20 毫米的结石，该结石位于胆囊壶腹内。随后，血清胆红素水平和炎症标志物显著降低，符合 Mirizzi 综合征的缓解标准。SGEHL 和 LAMS 的联合应用（SLAMS）为这种潜在危及生命的疾病提供了一种新的、微创的干预方法。
