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Hemorrhagic Acute Cholecystitis Causing Mirizzi Syndrome

Hemorrhagic Acute Cholecystitis Causing Mirizzi Syndrome 770 THE RED SECTION Image 1 1 1 1 Chikara Shirata, MD , Nicolas Demartines, MD, FACS, FRCS , Maurice Matter, MD and Gaetan-Romain Joliat, MD Am J Gastroenterol 2023;118:770. https://doi.org/10.14309/ajg.0000000000002169; published online December 29, 2022 A 39-year-old man with history of lung transplantation for cystic fibrosis was referred to our tertiary center for hemorrhagic cholecystitis. He underwent inguinal hernia repair in another hospital the week before and presented right upper abdominal pain 5 days later. Physical examination was positive for the Murphy sign. Laboratory tests revealed hyperbilirubinemia (113 mmol/L), elevated C-reactive protein (192 mg/L), and leukocytosis (20.3 g/L). Abdominal ultrasonography and magnetic resonance imaging revealed acute acalculous cholecystitis with heterogeneous hematomas in the gallbladder (a), con- firming the diagnosis of hemorrhagic cholecystitis. Moreover, obstructive jaundice caused by extrinsic compression of the common hepatic duct because of gallbladder distension, corresponding to Mirizzi syndrome, was suspected (b). The patient underwent surgical exploration that confirmed hemorrhagic cholecystitis and compression of the common hepatic duct (c). Cholecystectomy was performed. Intraoperative cholangiography demonstrated dilatation of intrahepatic bile ducts and contrast passage into the duodenum (d). Pathology results showed light acute cholecystitis without presence of gallstones and hemorrhage within the gallbladder wall. After surgery, recovery was uneventful, and serum bilirubin on postoperative day 1 decreased to 47 mmol/L. Cholecystitis can infrequently induce intraluminal and intramural gallbladder hemorrhage. Distended gallbladder because of hemorrhagic cholecystitis can be a rare cause of Mirizzi syndrome. Treatment remains early cholecystectomy. (Informed consent was obtained from the patient to publish these images.) Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland. Correspondence: Nicolas Demartines, MD, FACS, FRCS. Email: demartines@chuv.ch. The American Journal of GASTROENTEROLOGY VOLUME 118 | MAY 2023 www.amjgastro.com Copyright © 2023 by The American College of Gastroenterology. Unauthorized reproduction of this article is prohibited. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Gastroenterology Wolters Kluwer Health

Hemorrhagic Acute Cholecystitis Causing Mirizzi Syndrome

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Publisher
Wolters Kluwer Health
Copyright
© 2023 by The American College of Gastroenterology
ISSN
0002-9270
eISSN
1572-0241
DOI
10.14309/ajg.0000000000002169
Publisher site
See Article on Publisher Site

Abstract

770 THE RED SECTION Image 1 1 1 1 Chikara Shirata, MD , Nicolas Demartines, MD, FACS, FRCS , Maurice Matter, MD and Gaetan-Romain Joliat, MD Am J Gastroenterol 2023;118:770. https://doi.org/10.14309/ajg.0000000000002169; published online December 29, 2022 A 39-year-old man with history of lung transplantation for cystic fibrosis was referred to our tertiary center for hemorrhagic cholecystitis. He underwent inguinal hernia repair in another hospital the week before and presented right upper abdominal pain 5 days later. Physical examination was positive for the Murphy sign. Laboratory tests revealed hyperbilirubinemia (113 mmol/L), elevated C-reactive protein (192 mg/L), and leukocytosis (20.3 g/L). Abdominal ultrasonography and magnetic resonance imaging revealed acute acalculous cholecystitis with heterogeneous hematomas in the gallbladder (a), con- firming the diagnosis of hemorrhagic cholecystitis. Moreover, obstructive jaundice caused by extrinsic compression of the common hepatic duct because of gallbladder distension, corresponding to Mirizzi syndrome, was suspected (b). The patient underwent surgical exploration that confirmed hemorrhagic cholecystitis and compression of the common hepatic duct (c). Cholecystectomy was performed. Intraoperative cholangiography demonstrated dilatation of intrahepatic bile ducts and contrast passage into the duodenum (d). Pathology results showed light acute cholecystitis without presence of gallstones and hemorrhage within the gallbladder wall. After surgery, recovery was uneventful, and serum bilirubin on postoperative day 1 decreased to 47 mmol/L. Cholecystitis can infrequently induce intraluminal and intramural gallbladder hemorrhage. Distended gallbladder because of hemorrhagic cholecystitis can be a rare cause of Mirizzi syndrome. Treatment remains early cholecystectomy. (Informed consent was obtained from the patient to publish these images.) Department of Visceral Surgery, Lausanne University Hospital CHUV, University of Lausanne (UNIL), Lausanne, Switzerland. Correspondence: Nicolas Demartines, MD, FACS, FRCS. Email: demartines@chuv.ch. The American Journal of GASTROENTEROLOGY VOLUME 118 | MAY 2023 www.amjgastro.com Copyright © 2023 by The American College of Gastroenterology. Unauthorized reproduction of this article is prohibited.

Journal

American Journal of GastroenterologyWolters Kluwer Health

Published: May 29, 2023

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