Compression of Common Hepatic Duct (CHD) Caused by Dilated Cystic Duct, is it Another Variant or New Type of Mirizzi Syndrome: A Case Report

Background : Narrowing or obstructing of Common Bile Duct (CBD) by gallstone impacted in distal cystic duct is known as Mirizzi Syndrome (MS). However, the compression of Common Hepatic Duct (CHD) because of the enlargement of cystic duct due to the impacted stone in the distal cystic duct has never been reported. Case Report: A 60 year old man, Indonesian Javanese ethnicity, came to the hospital with bile duct stone and obstructive jaundice due to the compression of Common Hepatic Duct (CHD) because of the enlargement of cystic duct. In this case, the stone just lies in the tip of the cystic duct causing obstruction of cystic duct but the stone does not directly compress the CBD. Long cystic duct with mid or low insertion into CBD possibly occurs in this case. The diagnosis of this case is common hepatic duct obstruction caused by the enlargement of cystic duct. Two surgeries were performed, the first surgery was only cholecystectomy, and the second surgery was taking out the remnant of cystic duct including the stone inside. The outcome of the surgery was good, and the patient was allowed to go home from the hospital without further complaints. This rare case cannot be grouped into the existing classification of Mirizzi syndrome. May this case be grouped as another variant or a new type of Mirizzi Syndrome ? This case could be grouped as type I-a of Mirizzi syndrome according to the classification of Mc. Sherry, Beltran or Csendes. Conclusion : In Mirizzi syndrome the obstruction of CBD is not only caused directly by the stone in distal cystic duct, but also it can be caused by the enlargement of the cystic duct. This type of bile duct obstruction has never been reported before and this rare case cannot be grouped into the existing classification of Mirizzi syndrome. It is important for surgeons to recognize similar cases in the future, misinterpretation of imaging findings of bile duct obstruction makes surgery difficult and harmful for the patient.