# A Rare Case of Pseudo-Mirizzi Syndrome Presenting With Acute-on-Chronic Cholecystitis and Hepatic Abscesses

## TL;DR

This paper reports a rare case of pseudo-Mirizzi syndrome complicated by gallbladder inflammation and liver abscesses, managed with ERCP and surgery.

## Contribution

The paper presents the first documented case of pseudo-Mirizzi syndrome associated with hepatic abscesses and confirmed chronic cholecystitis.

## Key findings

- Pseudo-Mirizzi syndrome was confirmed with chronic cholecystitis via histopathology.
- The case was complicated by hepatic microabscesses, a rare occurrence in acalculous biliary disease.
- ERCP with sphincterotomy and cholecystectomy provided successful management.

## Abstract

Mirizzi syndrome (MS) is an uncommon cause of gallstone disease caused by calculous cholecystitis resulting in extrinsic obstruction of the common bile duct, causing concurrent obstructive jaundice. An acalculous variant of MS, at times referred to as pseudo-MS, occurs even more rarely. We present the case of a patient who was found to have pseudo-MS complicated by several hepatic microabscesses. The patient was managed with an endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and eventual cholecystectomy, with histopathology of the gallbladder confirming chronic cholecystitis. To our knowledge, the case presented here is the first in literature that identified pseudo-MS in a patient with pathology-confirmed chronic cholecystitis, and the first to be associated with hepatic abscesses; which usually occur with calculous rather than acalculous biliary disease.