Gallbladder ADENOCARCINOMA COURSE WITH MIRIZZI SYNDROME: CASE REPORT

• DOI: 10.22533/at.ed.1592582229096

• Palavras-chave: gallbladder adenocarcinoma; Mirizzi syndrome; jaundice; bile ducts

• Keywords: gallbladder adenocarcinoma; Mirizzi syndrome; jaundice; bile ducts

• Abstract:

  Introduction: Gallbladder carcinoma (BVC) is the most common malignant neoplasm of the bile ducts, affecting more women in their sixties. It most commonly presents as an asymptomatic condition, but it can also present non-specific symptoms, or even mimic other biliary diseases, such as Mirizzi's syndrome (a biliary pathology characterized by obstructive jaundice). Tumor resection in early stages can be curative, but due to the lack of effective screening tests, its diagnosis usually occurs at a late stage, dramatically worsening the prognosis of the disease. In this case report, we approach a patient with gallbladder cancer associated with Mirizzi syndrome.

  Case report: Female patient, 59 years old, consulted at the surgery outpatient clinic of Santa Casa de Misericórdia de Fortaleza with complaints of jaundice associated with pruritus, fecal acholia and choluria. Initially, abdominal ultrasound was performed, which showed dilatation of the intrahepatic bile ducts, but without identification of obstructive factors. She was submitted to an resonance cholangiography which showed luminal narrowing at the level of the confluence of the hepatic ducts due to probable extrinsic compression of the gallbladder. Cholecystectomy was performed with partial hepatectomy sufficient to guarantee a surgical margin. During dissection of the hepatic pedicle, invasion of the left hepatic duct was observed, which was resected and a biliary anastomosis of the hepatic ducts with the jejunum was performed. Histopathological analysis of the gallbladder confirmed the diagnosis of adenocarcinoma.

  Conclusion: Concomitance of gallbladder adenocarcinoma with Mirizzi syndrome is rare. Detailed clinical history and imaging tests are sometimes not sufficient for diagnosis, requiring the association of histopathological methods to avoid underdiagnosis of this condition.