Endoscopic and Surgical Management of a Hayes Type III-G Cystic Duct Anomaly Causing a Mirizzi Type I Syndrome

A Mirizzi Type I syndrome usually occurs as the result of gallstones impacting in the cystic duct or Hartmann’s pouch and then causing external compression of the common hepatic duct. It is described as an infrequent cause of obstructive jaundice occurring in only 0.7-1.1% of cholecystectomies. In this case report, we present a case of Mirizzi Syndrome associated with an impacted calculus in the gallbladder, an absent cystic duct (Hayes Type II-G anomaly) and a coincidental common bile duct stone. ERC diagnosed the syndrome, defined the anatomical variation and through interim stenting allowed the patient to recover A 65 year old female presented with a four-day history of abdominal pain and deepening jaundice. The day prior to admission she developed fever and rigors. Examination confirmed a deep jaundice, moderate to severe dehydration and tenderness in the right upper quadrant. The blood pressure was 100/60 and she had a pulse of 100/min. Her temperature was 38C, white cell count 4.7 (xl09/L). Platelets 84 (xl09/L), INR 1.1, APTT 27. Urea was 17.8 mmol/1 and Creatinine 0.147mmol/1. Liver function tests; AP 97 U/L, GGT 260 U/L, ALT 45 U/L, AST 35 U/L, Bilirubin 245 tmol/1 and a normal amylase.