PMC7701885_01
Two different scans (A e B) of MRCP showing infundibulum of gallbladder next to common bile duct.
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An MRCP (Magnetic Resonance Cholangiopancreatography) identified a mild dilatation of intrahepatic bile ducts, and a normal common bile duct (6 mm diameter) with a 4 mm biliary stone and sludge inside it (Fig. 1).
Cholangiography during ERCP: A, cannulation achieved with a gastroscope; B,C, Opacification of biliary tree with infundibulum of gallbladder compressing common bile duct (Mirizzi Syndrome Type I); D: Complete opacification of biliary tree, including gallbladder.
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Therefore cannulation of papilla was achieved through the gastroscope thanks to the high expertise of the endoscopist (Fig. 2A). Cholangiography showed common bile duct without any defect, but it showed a cystic duct with a biliary stone inside, compressing common bile duct with an hepatic duct and intrahepatic duct dilated (Fig. 2B-D).
Cholangiography during laparoscopic cholecystectomy: cystic duct and infundibulum (arrow) brought away from common bile duct before section of duct itself. CBD does not result compressed anymore.
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Laparoscopic cholecystectomy was performed, observing a cystic duct adhering to common bile duct, confirmed during an intra-surgery cholangiography once again (Mirizzi Syndrome - Fig. 3).
CT scan of abdomen: a mediocre view of common bile duct (red arrow) adhered and partially compressed from infundibulum (white arrow).
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A second look of the CT scan previously performed showed infundibulum adhering common bile duct (Fig. 4).
Cholangiography through biliary "pigtail" drainage two days after cholecystectomy: normal biliary tree with regular contrast flow into duodenum (arrow).
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Two days after surgery cholangiography through biliary "pigtail" drainage was performed, confirming the lack of a biliary leak, a normal CBD and a correct biliary flow into duodenum (Fig. 5).