Abstract

BENITEZ BELTRAN, Javier; HERNANDEZ MARCELO, Gustavo  and  GUZMAN ARGUELLO, Gloria María. A rare coexistence of cholecystobiliary and cholecistoenteric fistula with pyogenic abscesses. Report of a case. Cir. gen [online]. 2021, vol.43, n.4, pp.251-258.  Epub June 09, 2023. ISSN 1405-0099.  https://doi.org/10.35366/109129.

In October of 2019 we treated a rare combination of pyogenic liver abscess and Mirizzi syndrome (MS) type V in a 49 years-old female patient with abdominal pain and jaundice. We detected through laboratory, endoscopic and radiologic studies, a biliary obstruction due to a 2 cm biliary gallstone located in the common hepatic duct, pneumobilia, fever, leukocytosis and a severe inflammatory response, hence, surgery was required. During the intervention we found a scleroatrophic gallbladder, double fistulae to common hepatic duct and the duodenum. The case was solved with a cholecystectomy, closure of cholecistoduodenal fistulae, and a biliodigestive derivation with a yeyunal-hepatic anastomoses with Hepp technique. The right lobe liver abscesses were documented and drained by interventional radiology under ultrasound and CT guidance. Our patient required intensive care, antibiotics and total parenteral nutrition. She remained for 50 days in two hospitals and was discharged to outpatient care to continue observation of the liver abscesses with ultrasound and continued with antibiotics according to the results of the bacterial culture. Negative malignancy was reported for the scleroatrophic gallbladder.

Keywords : Mirizzi syndrome; pyogenic liver abscess; cholecystobiliary fistulas; cholecystoenteric fistulas.