PMC3556401_01
Abdominal ultrasound showing a gallbladder with thick walls and one large gallstone (50 mm) entrapped into the Hartmann pouch.
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fig1
Abdominal ultrasound showed a gallbladder with thick walls, one large gallstone (50 mm) entrapped into the Hartmann pouch (Figures 1(a) and 1(b)) and compressing the common hepatic duct which was dilated (8 mm) in its extrahepatic tract above the level of the obstruction and not sonographically observable under the level of obstruction (Figure 2).
Abdominal ultrasound showing compression of the common hepatic duct which was dilated (8 mm) in its extrahepatic tract above the level of the obstruction (white arrow) and not sonographically observable under the level of obstruction.
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fig2
Abdominal ultrasound showed a gallbladder with thick walls, one large gallstone (50 mm) entrapped into the Hartmann pouch (Figures 1(a) and 1(b)) and compressing the common hepatic duct which was dilated (8 mm) in its extrahepatic tract above the level of the obstruction and not sonographically observable under the level of obstruction (Figure 2).
Abdominal computed tomography confirming the ultrasound findings and excluding malignancy in the porta hepatis area, in the liver, and in the pancreas.
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fig3
Magnetic resonance cholangiography (MRC) showing presence of one large stone (45 mm) in a gallbladder with thick walls and one smaller stone (12 mm) in the cystic duct with a fistula involving the common bile duct which was dilated above the fistula level and normal below. The white arrows show the two stones.
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Intraoperative picture showing the common bile duct fistula.
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fig5
Through a subcostal incision, the gallbladder was detached from the liver, then it was opened, and after removing the bigger stone, the smaller one was seen in the cystic duct with a fistula involving up to two-thirds of the circumference of the common bile duct (Figure 5), hereby the confirmation of a type III Mirizzi syndrome.