We report a case of an extrahepatic bile duct
metastasis from a
gallbladder cancer that mimicked
Mirizzi's syndrome on cholangiography. A 67-yr-old woman was admitted to our hospital with a diagnosis of acute calculous
cholecystitis. As
obstructive jaundice developed after the admission, percutaneous transhepatic biliary drainage was performed to ameliorate the
jaundice and to evaluate the biliary system. Tube cholangiography revealed
bile duct obstruction at the hepatic hilus, and extrinsic compression of the lateral aspect of the common hepatic duct, with nonvisualization of the gallbladder. No impacted cystic duct stone was visualized on CT or ultrasonography.
Laparotomy revealed a gallbladder
tumor as well as an extrahepatic bile duct
tumor. We diagnosed that the latter was a
metastasis from the
gallbladder cancer, based on the histopathological features. This case is unique in that the extrahepatic bile duct
metastasis obstructed both the common hepatic duct and the cystic duct, giving the appearance of
Mirizzi's syndrome on cholangiography. Metastatic bile duct
tumors that mimic
Mirizzi's syndrome have not been previously reported. The presence of this condition should be suspected in patients with the cholangiographic features of
Mirizzi's syndrome, when the CT or ultrasonographic findings fail to demonstrate an impacted cystic duct stone.