Case Report Minimally Invasive Treatment of Mirizzi Syndrome, a Rare Cause of Cholestasis in Childhood Ahmet Ali Tuncer, 1 Sezgin Yilmaz, 2 Mustafa Yavuz, 2 and Salih ÇetinkurGun 1 1 Department of Pediatric Surgery, Afyon Kocatepe University Hospital, Afyonkarahisar, Turkey 2 Department of General Surgery, Afyon Kocatepe University Hospital, Afyonkarahisar, Turkey Correspondence should be addressed to Ahmet Ali Tuncer; drtaali@yahoo.com Received 31 July 2016; Accepted 4 October 2016 Academic Editor: Larry A. Rhodes Copyright © 2016 Ahmet Ali Tuncer et al. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Mirizzi syndrome is the compressive blockage of the cystic or choledochal duct caused by a biliary stone occupying the cystic canal or Hartmann’s pouch. Tis occurrence is rare and, in English literature, three cases defned in children have been observed. In order to draw attention to this rare occurrence, we preferred a 14-year-old male patient with Mirizzi syndrome. In this case, ERCP was performed preoperatively and the diagnosis was carried out with the help of clear visualisation and identifcation of the tissue structures as well as the stent placed in bile duct; so we protected the patient from the possible iatrogenic injury occurring during surgery. 1. Introduction Mirizzi syndrome is the compressive blockage of the cystic or choledochal duct caused by a biliary stone occupying the cystic canal or Hartmann’s pouch. It was frst described in 1948 by Mirizzi [1], clinically characterized by intermittent or persistent obstructive jaundice. It is more common in patients with cholelithiasis for a long time and women [2]. Tere are three cases defned in children in English literature [3–5]. Factors that make this patient population special is the difculty in preoperative diagnosis and treatment, with an additional high risk of iatrogenic damage to the biliary system. In order to draw attention to this rare occurrence, we preferred a 14-year-old male patient with Mirizzi syndrome. 2. Case Presentation A fourteen-year-old male patient applied to our clinic with a 1-week history of right upper quadrant pain and icteric sclera. Physical examination revealed the tenderness on Murphy’s point and jaundice extending down to the body. Labora- tory examinations were consistent with obstructive jaundice (aspartate aminotransferase: 141 U/L, alanine aminotrans- ferase: 230 U/L, gamma-glutamyl transpeptidase: 219, total bilirubin: 7.81 mg/dL, conjugated bilirubin: 7.4 mg/dL, white blood cell: 12.1 × 10 3 /L, and neutrophil: 8.9 × 10 3 /L). Afer ultrasonography was performed on the patient that revealed cholelithiasis and cholestasis, endoscopic retrograde cholan- giopancreatography (ERCP) was planned. During ERCP, it seemed that the cystic duct is quite weak and inside Hart- mann’s pouch compressed the choledoc flled with stones. Sphincterotomy was carried out. Afer the choledochal canals were cleaned, a choledochal stent was replaced (Figure 1). Laparoscopic cholecystectomy was carried out a day later. During laparoscopy, choledochal compression caused by Hartmann pouch was clearly seen (Figure 2). Te patient was discharged afer being observed to have normal postoperative bilirubin values. Choledochal stent was taken by endoscopy on the frst postoperative month. In Mirizzi syndrome since the gallbladder compresses the choledochus and eventually causes obstructive jaundice, it should be removed. Since the patient was admitted with cholecystitis and obstructive jaundice, a preoperative ERCP should be planned in order to normalize the jaundice and clarify the etiology as in our patient. An immediate laparoscopic cholecystectomy should be planned just afer the ERCP. Cholecystectomy was carried out under general anesthesia but endoscopies were Hindawi Publishing Corporation Case Reports in Pediatrics Volume 2016, Article ID 8940570, 3 pages http://dx.doi.org/10.1155/2016/8940570