Giant Gallbladder Empyema in Mirizzi Syndrome
A 42-year-old man with mild scleral icterus (bilirubin 2.87 mg/dL [≤ 1.2 mg/dL]) and a massive increase in abdominal girth over a period of only a few weeks was referred to our department for further investigation. Initial upper abdominal sonography had shown a large, cystic abdominal process of uncertain origin. A superinfection had been suspected (C-reactive protein [CRP] 167.7 mg/L [<5 mg/L]; leukocytes 10.56/ nL [<10.50/ nL] and antibiotic treatment initiated.
Both repeat upper abdominal sonography and computer tomography demonstrated an enormous subhepatic cystic mass measuring circa 30 x 20 x 30 cm (Figure). The origin of the lesion was unclear, and Echinococcus serology was negative. We suspected a myxomatous process and therefore opted for laparoscopic evaluation rather than diagnostic aspiration. Intraoperatively the laparoscopy was extended to median laparotomy. A total of 15 L of purulent bilious fluid was drained from the cystic lesion, which on further exploration turned out to be a hugely expanded gallbladder with multiple gallstones of up to 3 x 4 cm. The finding that an impacted stone in the infundibulum of the gallbladder had compromised the common hepatic duct pointed to the diagnosis of gigantic gallbladder empyema in Mirizzi syndrome.
Prof. Dr. med. Marcus Bahra, Klinik für Chirurgie, Charité – Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin
PD Dr. med. Dominik Geisel, Klinik für Strahlenheilkunde, Charité – Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin
PD Dr. med. Tobias Müller, M. D., Medizinische Klinik mit Schwerpunkt Hepatologie und Gastroenterologie, Charité – Universitätsmedizin Berlin, Campus Virchow Klinikum, Berlin, firstname.lastname@example.org
Conflict of interest statement: The authors declare that no conflict of interest exists.
Translated from the original German by David Roseveare
Cite this as: Bahra M, Geisel D, Müller T: Giant gallbladder empyema in Mirizzi syndrome. Dtsch Arztebl Int 2019; 116: 300.. DOI: 10.3238/arztebl.2019.0300a