Electrohydraulic Lithotripsy in the Treatment of the Mirizzi Syndrome. A Clinical Case
https://doi.org/10.25207/1608-6228-2019-26-5-116-124
Abstract
Aim. To present an interesting case of treating cholelithiasis in the setting of the Mirizzi syndrome.
Materials and methods. This paper presents a clinical case of patient A. (62 years old) who was admitted to hospital with the following diagnosis: cholelithiasis, cholecysto-choledocholithiasis, obstructive jaundice. Drawing on the medical history and complaints of the patient, as well as on the results of physical, laboratory, instrumental and preliminary examination, the patient was diagnosed with choledocholithiasis in the setting of the Mirizzi syndrome. Endoscopic retrograde cholangiopancreatography (ERCP) was prescribed. The ERCP was performed in four stages. The first stage included a typical endoscopic papillotomy, a retrograde cholangiopancreatography, as well as an attempt at endoscopic mechanical lithoextraction; however, the calculus could not be removed. During the second stage, the calculus was visually localized, and its size was determined. The third stage consisted in performing electrohydraulic lithotripsy (EHL) and mechanical lithoextraction of calculus fragments. The final, fourth stage involved follow-up direct cholangioscopy, which revealed that the common bile duct was patent and there were no calculi.
Results. EHL constitutes a high-tech method of crushing calculi, which provides an opportunity to carry out minimally invasive treatment in patients with complicated cases of choledocholithiasis, when standard methods of mechanical lithoextraction are not effective.
About the Authors
Sergei A. Gabriel
Kuban State Medical University; Region Clinic Hospital No 2
Russian Federation
Russian Federation
Dr. Sci. (Med.), Ass. Prof., Surgery Department No. 3, Faculty of Advanced Training and Occupational Retraining; Acting Chief Physician
Shkolnaya str., 15/5, Krasnodar, 350059; tel.: +7 (988) 242-65-17
Aleksandr Y. Guchetl
Kuban State Medical University; Region Clinic Hospital No 2
Russian Federation
Russian Federation
Cand. Sci. (Med.), Ass. Prof., Surgery Department No. 3, Faculty of Advanced Training and Occupational Retraining; Head of the Centre for Minimally Invasive Surgical Interventions
Mitrofanа Sedina str., 4, Krasnodar, 350063; Krasnykh partizan str., 6/2, Krasnodar, 350012
Vladimir M. Durleshter
Kuban State Medical University; Region Clinic Hospital No 2
Russian Federation
Russian Federation
Dr. Sci. (Med.), Prof., Head of the Surgery Department No. 3, Faculty of Advanced Training and Occupational Retraining; Deputy Chief Surgeon
Mitrofanа Sedina str., 4, Krasnodar, 350063; Krasnykh partizan str., 6/2, Krasnodar, 350012
Viktor Yu. Dynko
Region Clinic Hospital No 2
Russian Federation
Russian Federation
Cand. Sci. (Med.), Head of the Endoscopy Department
Krasnykh partizan str., 6/2, Krasnodar, 350012
Ruslan M. Tlekhuray
Kuban State Medical University; Region Clinic Hospital No 2
Russian Federation
Russian Federation
Cand. Sci. (Med.), Research Assistant, Surgery Department No. 3, Faculty of Advanced Training and Occupational Retraining; endoscopist, Endoscopy Department
Mitrofanа Sedina str., 4, Krasnodar, 350063; Krasnykh partizan str., 6/2, Krasnodar, 350012
Mikhail V. Bespechnyi
Region Clinic Hospital No 2
Russian Federation
Russian Federation
Endoscopist, Endoscopy Department
Krasnykh partizan str., 6/2, Krasnodar, 350012
Adam K. Mamishev
Region Clinic Hospital No 2
Russian Federation
Russian Federation
Endoscopist, Endoscopy Department
Krasnykh partizan str., 6/2, Krasnodar, 350012
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Review
For citations:
Gabriel S.A., Guchetl A.Y., Durleshter V.M., Dynko V.Yu., Tlekhuray R.M., Bespechnyi M.V., Mamishev A.K. Electrohydraulic Lithotripsy in the Treatment of the Mirizzi Syndrome. A Clinical Case. Kuban Scientific Medical Bulletin. 2019;26(5):116-124. (In Russ.) https://doi.org/10.25207/1608-6228-2019-26-5-116-124
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