Mirizzi syndrome complicated with a cholecystocolic fistula (CCF) is classified as
Mirizzi syndrome type V [1]. Although surgical management with cholecystectomy, fistula takedown, and possible
colonic resection is indicated as the standard treatment for Mirizzi syndrome complicated
with CCF [2]
[3]
[4], we describe successful management of such a case using endoscopic therapy alone
([Video 1]).
Successful complete endoscopic stone removal and cholecystocolic fistula closure for
Mirizzi syndrome type V.Video 1
A 50-year-old man was admitted to our hospital with jaundice. Magnetic resonance cholangiopancreatography
revealed stones filling the gallbladder and causing a stricture of the hilar bile
duct, resulting in the diagnosis of Mirizzi syndrome ([Fig. 1]). We performed endoscopic retrograde cholangiopancreatography (ERCP). Cholangiography
revealed the hilar biliary stricture due to gallbladder stones and contrast medium
flowed from the hilar bile duct into the gallbladder, resulting in the diagnosis of
a cholecystobiliary fistula ([Fig. 2]). A nasobiliary drain was placed in the intrahepatic bile duct, and after the improvement
of jaundice, ERCP was repeated. Peroral cholangioscopy revealed gallbladder stones
protruding into the hilar bile duct through the cholecystobiliary fistula ([Fig. 3]), and electrohydraulic lithotripsy (EHL) was performed. Five ERCP with EHL sessions
resulted in the complete removal of the gallbladder stones. However, cholecystography
revealed that the CCF and colon were contrasted ([Fig. 4]
a). Cholangioscopy-guided biopsies of the CCF revealed no malignancy. Therefore, we
inserted a guidewire through the CCF into the colon ([Fig. 4]
b) and placed a nasal catheter in the colon ([Fig. 4]
c). We then performed a colonoscopy through which the CCF was easily detected at the
hepatic flexure using the placed nasal catheter as a marker ([Fig. 5]
a). After removing the nasal catheter, the CCF was successfully closed with a large
grasping clip (MANTIS Clip; Boston Scientific, Marlborough, Massachusetts, USA) ([Fig. 5]
b). Complete endoscopic removal of gallbladder stones and endoscopic CCF closure were
successfully performed for Mirizzi syndrome type V complicated with CCF, thus avoiding
surgery.
Fig. 1 Magnetic resonance cholangiopancreatography revealed stones filling the gallbladder
and causing a stricture of the hilar bile duct.
Fig. 2 Cholangiography revealed the hilar biliary stricture due to gallbladder stones and
inflow of contrast medium from the hilar bile duct into the gallbladder. A guidewire
was inserted from the hilar bile duct into the gallbladder, indicating the cholecystobiliary
fistula.
Fig. 3 Cholangioscopy revealed a stone protruding from the gallbladder through the cholecystobiliary
fistula into the hilar bile duct.
Fig. 4
a Cholecystography revealed the cholecystocolic fistula, and the colon was contrasted
(arrowheads). b A guidewire was inserted through the cholecystocolic fistula into the colon. c A nasal catheter was placed in the colon.
Fig. 5
a The cholecystocolic fistula at the hepatic flexure was easily identified during colonoscopy
with the nasal catheter placed as a marker. b After removing the nasal catheter, the cholecystocolic fistula was successfully closed
with a large grasping clip.
Endoscopy_UCTN_Code_TTT_1AR_2AH
E-Videos is an open access online section of the journal Endoscopy, reporting on interesting cases and new techniques in gastroenterological endoscopy.
All papers include a high-quality video and are published with a Creative Commons
CC-BY license. Endoscopy E-Videos qualify for HINARI discounts and waivers and eligibility is automatically checked during the submission
process. We grant 100% waivers to articles whose corresponding authors are based in
Group A countries and 50% waivers to those who are based in Group B countries as classified
by Research4Life (see: https://www.research4life.org/access/eligibility/).
This section has its own submission website at https://mc.manuscriptcentral.com/e-videos.
