S3304 Clinical Presentation and Management of Type I Mirizzi Syndrome Following Laparoscopic Cholecystectomy: A Case Report of Surgical Clip-Induced Liver Injury

Introduction: Mirizzi syndrome is a rare condition characterized by the mechanical obstruction of the common bile duct (CBD) due to impacted gallstones in the cystic duct or at the neck of the gallbladder, often occurring in the context of cholecystitis or after cholecystectomy. Here, we present a case of Type I Mirizzi Syndrome induced by a migrated cholecystectomy clip compressing the CBD following laparoscopic cholecystectomy. Case Description/Methods: A 49-year-old man presented with right upper quadrant pain, nausea and vomiting, 12 days post-laparoscopic cholecystectomy. Physical examination revealed icterus, and laboratory results showed elevated liver enzymes, including bilirubin. Abdominal ultrasound and magnetic resonance cholangiopancreatography (MRCP) confirmed CBD compression. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a narrowed CBD (3 mm) caused by extrinsic obstruction. Patient was taken for surgery to further evaluate and remove the extrinsic compression. Due to significant inflammation and dense adhesions, the patient was converted from laparoscopic to open surgery, which confirmed the extrinsic compression by migration of a cholecystectomy clip. Following surgical intervention, the patient showed marked clinical improvement with symptoms resolution. Total bilirubin decreased from 8.6 mg/dl to 2.8 mg/dl, and liver function tests improved significantly, with AST decreasing from 1015 U/L to 205 U/L and ALT from 1510 U/L to 315 U/L. The postoperative course was uncomplicated. Discussion: This case underscores the importance of early diagnosis and timely surgical intervention in Mirizzi Syndrome specifically when related to post-cholecystectomy complications such as surgical clip migration. This study highlights the significance of proper preoperative planning and assessing of the Mirizzi syndrome in patients with cholecystitis and gallstones to ensure optimal management and prevention of possible complications.