Fístula biliar iatrogénica post colecistectomía por síndrome de mirizzi a propósito de un caso

Abstract

Introduction: The biliary fistula is an abnormal communication between the biliary tract and other organs, its incidence is between 1 and 2%. They are grouped into internal and external. The diagnosis can be carried out during surgery; however most are detected in the early or late postoperative period. Surgical treatment is a challenge that requires knowledge of the pathology, bile duct injury, and digestive tract involvement. Mirizzi syndrome is a rare complication of gallstone pathology, which is caused by inflammation caused by extrinsic compression of a stone that is impacted in the Hartmann's bag with a partial or complete obstruction of the bile duct. ERCP is a diagnostic and therapeutic method, either temporarily or permanently. Objective: Characterize patients with post-laparoscopic cholecystectomy biliary fistula due to Mirizzi Syndrome and determine its management. Materials and methods: A descriptive cross-sectional study based on clinical case analysis is carried out. Discussion: This is a 25-year-old female patient, who was admitted with cholecystitis, for which a laparoscopic cholecystectomy was performed. Patient is discharged but after 11 days of surgical treatment he is admitted to a private hospital in a fair general condition, where they diagnose: post-surgical uncontrolled biliary fistula plus bilioperitoneum for which they perform diagnostic laparoscopy, lavage and drainage. However, his condition does not improve because of what he undergoes endoscopic cholangiography, papillotomy and trying to place a biliary prosthesis, which is the definitive treatment. Patient evolves favorably so she is discharged in good condition. Conclusions: Cholecystectomy is the gold standard for the treatment of stone disease. Iatrogenic lesions at the level of the bile ducts constitute a serious complication not only because of the difficulty in diagnosis, but also because of the high risk of morbidity and mortality. Mirizzi syndrome is an infrequent complication but should be suspected in patients with a history of lithiasic disease, its diagnosis in most cases is postoperative.