Successful endoscopic management with electrohydraulic lithotripsy in Mirizzi syndrome type I

Background: Mirizzi syndrome describes an obstruction of the common hepatic bile duct by external compression caused by an impacted gallstone in the cystic duct, leading to obstructive jaundice. The established treatment is surgical. Endoscopic treatment with electrohydraulic lithotripsy (EHL) gains importance to be an effective and safe alternative. Case Report: A 21-year-old woman with known cholecystolithiasis was referred with suspected choledocholithiasis. Endoscopic retrograde cholangiography (ERC) showed a Mirizzi syndrome. Surgical therapy was refused by the patient. Endoscopic procedure with EHL under cholangioscopic guidance was successfully performed, and complete stone clearance was achieved in one treatment session. The patient was discharged free of symptoms. A laparoscopic cholecystectomy was arranged. Conclusion: Mirizzi syndrome can be successfully treated endoscopically with EHL. Taking former studies into account, EHL in Mirizzi syndrome is a less expensive, safe and successful procedure. Future management of Mirizzi syndrome should be discussed interdisciplinary between surgeon and gastroenterologist in order to guarantee best individual therapeutic management.