P2947 - Mirizzi Syndrome: A Rare Case in Pregnancy

Mona Roknsharifi, MD, Femina Patel, MD, Carlos Buitrago, MD, Anas Kawayeh, MD, George Saffouri, MD
University of California Riverside, San Bernardino, CA

Introduction: Pregnancy has been associated with an increased risk of cholelithiasis. Mirizzi syndrome is a rare complication of cholelithiasis, which is characterized by extrinsic compression of the common bile duct (CBD) or common hepatic duct from an impacted stone in the cystic duct. We report a case of Mirizzi Syndrome in a pregnant patient.

Case Description/Methods: 27-year-old G4P3A1 Female at 26 weeks gestation with a history of recurrent gallstones, presented to the ER for intermittent right upper quadrant abdominal pain, fever, vomiting and jaundice for 3 weeks. She had similar episodes of symptomatic cholelithiasis in prior pregnancies, however did not follow up for subsequent cholecystectomy. She denied a history of abdominal surgeries, smoking, drinking, recreational drug use. She had no family history of liver disease or hereditary GI conditions. On arrival, HR 116, RR 20, BP 111/65, temperature 37.8, on room air. Her pertinent labs were Hb 11.6, WBC 9.5, Total bilirubin 4.2, ALT 124, AST 70, ALP 169, lipase 21, INR 1, PT 14.2. Her UA and drug screen was negative. The ultrasound of the abdomen showed a normally distended gallbladder. Gallbladder wall thickness was 4.5 mm. No pericholecystic fluid or gallstones or sonographic Murphy's sign was noted. MRCP showed an 11 mm stone compressing the common bile duct. The common bile duct was noted to be 15 mm dilated along with intrahepatic ductal dilatation. Endoscopic retrograde cholangiopancreatography (ERCP) was then performed showing dilated common bile duct and extrinsic compression of the CBD by a large stone lodged within the cystic duct consistent with Mirizzi syndrome type I. A biliary stent was placed with successful decompression. Next day, she underwent laparoscopic partial cholecystectomy. She tolerated the procedure and was discharged home the following day.

Discussion: Mirizzi syndrome is a rare etiology of obstructive jaundice. There is no case report in the literatures regarding pregnancy and Mirizzi syndrome in English language. Due to the high operative morbidity and mortality, the diagnosis should be made prior to surgery. Therefore, it is important to consider Mirizzi syndrome in the differential diagnosis of obstructive jaundice in a pregnant patient.



Disclosures:


Mona Roknsharifi, MD, Femina Patel, MD, Carlos Buitrago, MD, Anas Kawayeh, MD, George Saffouri, MD. P2947 - Mirizzi Syndrome: A Rare Case in Pregnancy, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.