Case Report

Elevated CA 19-9 Levels in a Patient with Mirizzi Syndrome: Case Report

Authors: Mayra Sanchez, MD, Hilton Gomes, MD, Erin N. Marcus, MD, MPH


CA 19-9 is a marker of malignancy of the pancreas and biliary tract. We report the case of a patient who had significantly elevated serum CA 19-9 levels and imaging studies suggestive of malignancy. On laparotomy, the patient was found to have Mirizzi syndrome, an uncommon cause of biliary obstruction from an impacted gallstone. This case illustrates that elevated serum CA 19-9 levels must be interpreted cautiously in cases of biliary obstruction.

Key Points

* Mirizzi syndrome occurs when the common hepatic duct becomes extrinsically obstructed by an impacted gallstone in the cystic duct or neck of the gallbladder.

* CA 19-9 is a sensitive marker for pancreatic and biliary cancer.

* Elevated serum CA 19-9 levels are usually lower than 1,000 units per mL in patients with benign reasons for obstruction.

* Elevated serum CA 19-9 levels should be interpreted cautiously in patients with benign obstruction of the biliary tree.

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