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- W2891397752 abstract "Background: Mirizzi's syndrome and laparoscopic cholecystectomy bile duct injury can lead to significant morbidity and mortality. We present a case of a high-risk surgical patient who underwent cholecystectomy for Mirizzi's Syndrome and found to have a large cholecholedochal fistula. The defect was repaired with choledochoplasty using a free flap of gallbladder wall with good result. This technique is never reported in the literature. Methods: An 82-year-old female nursing home resident with abdominal pain and jaundice was found to have two giant gallstones compressing the common bile duct (CBD) consistent with Mirizzi's syndrome. Her comorbidities included congestive heart failure and morbid obesity with BMI 42. ERCP showed external compression of the CBD and two stents were placed. Intraoperatively, two 4 cm gallstones were found in the gallbladder with necrosis in the neck. There was a large 3 x 0.8 cm CBD defect noted after removing the stones making primary repair impossible and hepaticojejunostomy had a significant high surgical risk. We used a free flap of gallbladder wall for choledochoplasty. The patient is well at 2.5 year follow up without sign of bile leak. Results: The CBD defect was successfully repaired with a gallbladder wall free flap. The patient remains well 2.5 years later on follow up with normalization of liver enzymes and without sign of a bile leak. Conclusion: Mirizzi's syndrome and laparoscopic CBD injury can happen in patients with significant comorbidity. Usually hepaticojejunostomy is required to repair the bile duct, which has a high complication and mortality rates in this subgroup of patients. Gallbladder wall free flap is a reasonable choice to repair the defects with good result and free flap survival like our case. The technique should be considered as an alternative to avoid morbidity and mortality in high-risk patients. Two giant gallstones found within the gallbladder causing compression of the common bile duct and Mirizzi's Syndrome with cholecholedochal fistula." @default.
- W2891397752 created "2018-09-27" @default.
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- W2891397752 date "2018-03-01" @default.
- W2891397752 modified "2023-10-16" @default.
- W2891397752 title "Choledochoplasty with gallbladder wall free flap: a novel technique for Mirizzi's syndrome and bile duct injuries in high risk patients" @default.
- W2891397752 doi "https://doi.org/10.1016/j.hpb.2018.02.555" @default.
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