Resumen

RODRIGUEZ GONZALEZ, Omaira et al. Resolución laparoscópica de litiasis vesicular complicada con fístula colecistobiliar y colecistoduodenal: Síndrome de mirizzi tipo V. a propósito de un caso complejo. RFM [online]. 2009, vol.32, n.2, pp.171-175. ISSN 0798-0469.

Case report of the laparoscopic resolution of a type V Mirizzi´s Syndrome. This syndrome is a rare complication of the choletihiasis that becomes a surgical challenge, especially if made under laparoscopy, because it demands special skills and equipments uncommon to the general surgeons. A 58 years old female patient who presents a two weeks history of obstructive biliary syndrome. Hepatic enzymes were high and abdominal ultrasonography revealed gallstones and a dilated common bile duct. Endoscopic retrograde pancreatography (ERCP) revealed biliary stones in the junction between cystic duct and the common bile duct and the instrumentation was not effective. The laparoscopic approach showed severe adherences around the gallbladder with a cholecystoduodenal fistula and a cholecystobiliary fistula. We continue with the dissection and resection of the cholecystoduodenal fistula using primary closure of the duodenum. Afterwards we performed the transcholedochal common bile duct exploration and the capture of a 1,5 cm stone. Then we proceed with the primary closure of the common bile duct and subtotal cholecystectomy at the Hartman’s pouch using a 45 mm lineal autosuture. The laparoscopic management of patient with gallstones and Mirizzi´s syndrome is a difficult situation for the surgical team. However it is possible and save whenever a surgical team and the require resources are available.

Palabras clave : Mirizzi’s syndrome; Complex common biliary duct stones; Cholecystoenteric fistula.