The vanishing Calot syndrome. A case report

DOI: 10.17605/OSF.IO/AM4B8

Garcia-Cruz MA, Pinto-Angulo VM, Reyes-Ramírez U, Cruz-Jiménez A, Garcia-Cruz EJ, Cordero-Jaimes SR, Diaz-Banegas SN.The vanishing Calot syndrome. A case report. Am J Med Surg. 2021; 5(2). 20-23

BACKGROUND. Vanishing Calot syndrome is an inflammatory status of the gallbladder that also involves the Calot triangle, obliterating it, there is no compression of the main bile duct. This entity is also referred as pseudo-Mirizzi Syndrome (pseudo-MS). The clinical importance of pseudo-MS is that misidentification remains the most common mechanism involved in post-cholecystectomy bile duct injury (BDI). Risk of misidentification increases when pathologic factors alter local anatomy.

The occurrence of BDI significantly affects morbidity and mortality, quality of life, and healthcare costs. The goal is to achieve a universal culture of safety in cholecystectomy. There are anatomic landmarks that may be helpful to safely achieve the critical view of safety referred as B-SAFE and R4U line, however, these anatomical landmarks are altered in case of severe inflammation and may not be reliable in these cases. We present the case of a 63-year-old male patient with acute grade II cholecystitis, pseudo-MS and anatomical variant of the biliary tract, successfully treated laparoscopically by careful dissection of the hepatocystic triangle until a critical view of safety is obtained even though the anatomical safety marks did not correspond to safe areas of dissection. However, the operating surgeon should be mindful of this entity during the procedure. If present, it should be taken as a red flag for the presence of its causes and makes for a difficult procedure with a high risk of BDI, and appropriate measures should be taken to complete the procedure safely.

 

KEY WORDS: Vanishing Calot syndrome, Mirizzi syndrome.