Markedly Elevated CA 19-9 in Type I Mirizzi Syndrome in the Absence of Malignancy: A Case Report.
Abdullahi Khalif Ali, Abdikani Mohamednor Mohamed, Abdirahman Ahmed Mohamud et al.
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Case in brief
A 50-year-old man presented with acute obstructive jaundice, fever, and right upper quadrant pain; serum CA 19-9 was 1000 U/mL. Triphasic contrast-enhanced CT showed Type I Mirizzi syndrome from an 11.9-mm gallstone impacted in Hartmann’s pouch, without evidence of malignancy. Dense adhesions obscured Calot’s triangle, so he underwent subtotal fenestrating cholecystectomy. After surgery, cholestatic liver tests improved markedly and CA 19-9 fell to 153 U/mL, supporting a benign obstructive and inflammatory explanation for the elevation.
What made this case unusual
CA 19-9 reached 1000 U/mL despite imaging showing Type I Mirizzi syndrome without malignancy, illustrating that severe benign biliary obstruction can produce a level strongly associated with pancreaticobiliary cancer.
Diagnostic / clinical pearl
Marked CA 19-9 elevation does not establish malignancy: in obstructive jaundice, consider benign biliary obstruction such as Mirizzi syndrome and interpret the marker alongside imaging and its change after relief of obstruction.
Why it matters
Recognizing this benign explanation may help avoid misdiagnosis and unnecessary aggressive surgical intervention.