Type I Mirizzi syndrome complicated by “Klatskin-mimicking” cicatricial-inflammatory stricture of the common bile duct

Objective: to study the diagnostic features and results of staged surgical treatment of type I Mirizzi syndrome with cicatricial-inflammatory stricture of the common bile duct.

Material and methods: this work presents an analysis of two clinical cases. Case No.1: Patient H., 67, with severe comorbidities and obstructive jaundice (bilirubin 587 μmol/L). Percutaneous transhepatic cholangiography and CT revealed extensive obstruction of the common bile duct (Bismuth-Corlette type I), suspicious for neoplasia. Case No.2: Patient S., 48, with acute calculous cholecystitis, type I Mirizzi syndrome, and concomitant biliary pancreatitis.

Results: in both cases, intraoperative findings revealed a dense inflammatory infiltrate and an extensive (more than 5cm) stricture of the common bile duct caused by pressure from a large calculus in Hartmann’s pouch. In the first case, a two-stage approach was implemented: percutaneous transhepatic cholangiodrainage (biliary decompression) followed by radical surgery. Due to pronounced sclerotic changes in the duct walls, precluding external drainage, resection of the common bile duct with formation of a Roux-en-Y hepaticojejunostomy on a defunctionalized (excluded) loop (70 cm) was performed in both cases. The benign nature of the strictures was confirmed by rapid biopsy and final histological examination (detection of hyalinized connective tissue with inflammatory infiltration without signs of atypia).

Conclusion: type I Mirizzi syndrome can be complicated by extensive cicatricial-inflammatory strictures of the common bile duct, mimicking a tumor process. A comprehensive diagnostic approach helps to determine an appropriate surgical procedure. For severe strictures, the optimal reconstruction method is a Roux-en-Y hepaticojejunostomy, while staged biliary decompression helps reduce surgical risks.

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