Mirizzi syndrome type Vb with cholecystogastric fistula causing gastric outlet obstruction: A case report

Figure 1 Immediate and 2-hour delayed fluoroscopic images showing delayed gastric emptying and subcompensated gastric outlet obstruction due to fixed narrowing of the pyloroduodenal region. A: Immediate fluoroscopic image showing contrast retention within the stomach; B: Two-hour delayed image demonstrating persistent contrast stasis, consistent with subcompensated gastric outlet obstruction due to impaired pyloroduodenal passage.

Figure 2  Magnetic resonance imaging showing gallstone disease with biliary outflow impairment and deformity of the extrahepatic bile duct at the level of the gallbladder neck.

Figure 3  Dense inflammatory conglomerate involving the gallbladder, hepatoduodenal ligament, and pyloroduodenal region identified during abdominal exploration, resulting in marked deformation of the gastric outlet (blue arrow).

Figure 4  Mobilization of the duodenum and stomach using the Kocher maneuver, allowing assessment of the extent and irreversibility of pyloroduodenal stenosis.

Figure 5 Cholecystectomy and gallstone extraction. A: Cholecystectomy with removal of gallstones; B: Removal of migrated gallstones from the pyloric stomach through the cholecystogastric fistula.

Figure 6 Distal gastrectomy and reconstruction. A: Distal gastrectomy involving approximately two-thirds of the stomach; B: Billroth II gastrojejunostomy (end-to-side, Hofmeister-Finsterer modification).

Figure 7  Intraoperative cholangiography demonstrating patency of the biliary tree and absence of residual choledocholithiasis.

Figure 8 Macroscopic pathological specimens. A: Macroscopic specimen of the resected distal stomach, gallbladder, and removed gallstones showing chronic inflammatory and cicatricial changes; B: Cross-sectional view of the stomach demonstrating fibrotic remodeling of the pyloric region.