Surgical management of Mirizzi syndrome during the pandemic in a COVID 19 referral center: Report of a case from a developing country

Abstract

Mirizzi syndrome (MS) is a rare complication of gallstone disease Surgical management may be complex, depending on the type of Mirizzi, and may range from simple cholecystectomy to a hepaticojejunostomy A 39-year-old female diagnosed previously to have gallstones was admitted in the Philippine General Hospital (PGH), a tertiary COVID 19 referral center presenting with obstructive jaundice, right upper quadrant pain and fever Hepatobiliary ultrasonography demonstrated a markedly distended gallbladder with a stone at the Hartmann's pouch A diagnosis of Mirizzi syndrome with cholangitis was made The patient was managed with broad spectrum antibiotics and scheduled for surgery No further imaging or endoscopy was requested due to the limitations brought about by the pandemic Upon a negative COVID 19 polymerase chain reaction (COVID 19 PCR) test result she underwent surgery, subtotal cholecystectomy, intraoperative cholangiography, and choledochoplasty No perioperative complications were noted This patient patient care while limiting risks from COVID 19 both to the patient and the health care team This case demonstrates the need to address issues brought about by the pandemic resulting in limitations in resources, added risk of morbidity to patients, and increased level of technical difficulty particularly in biliary surgery