Gallbladder wall perforation secondary to empyema in Mirizzi's syndrome: An unseen complication. A case report

Abstract

Introduction: Mirizzi's syndrome is a rare but potential complication of long standing gallstone disease, particularly cholecystolithiasis.

Case presentation: Being described is a case of a 42 year old patient who presented with right upper quadrant pain. Initially sent home as the pain settled but was diagnosed as Mirrizi's syndrome on readmission and was managed accordingly. This case report is being presented with the aim of highlighting the importance of Mirizzi's syndrome and the potential consequences it may bear.

Discussion: Due to lack of symptom specificity, this entity remains undiagnosed preoperatively in majority of the cases. Although safe in expert hands, minimally invasive approach (in selected types) can be challenging and bears the risk of bile duct injuries, with a high probability of conversion.

Conclusion: Delays in targeted management may lead to dire consequences ranging from empyema gallbladder to gangrene of gall bladder wall, perforation and frank sepsis. A thorough clinical history and physical examination and assessment in light of clinical investigations can lead to a timely diagnosis and management.

Keywords: Cholecystolithiasis; Choledocho-colic fistula; Gallbladder empyema; Mirizzi’s syndrome.