We hypothesized the missing link might be best explained by the presence of probable APS strengthened with other secondary thrombogenetic risk factors exist such as SLE, pancreatitis, stasis, drugs (oral contraceptives), or other traditional atherosclerosis risk factors that suspected to be present

in this patient. Conclusion: After investigation, we, therefore, proposed check details the pathomechanism in this patient as the following: suspected antiphospholipid syndrome -> splenic vein thrombus -> splenomegaly -> hypersplenism -> pancytopenia. Key Word(s): Na Presenting Author: GUNAWAN JEFFRI Additional Authors: RANGGA RABBINU, ADI PERDANA, SYAM ARI FAHRIAL, ALBAR ZULJASRI Corresponding Author: GUNAWAN JEFFRI Affiliations: University of

Indonesia, University of Indonesia, University of Indonesia, University of Indonesia Objective: Mirizzi syndrome defined as common hepatic duct obstruction caused by an extrinsic compression Decitabine datasheet from an impacted stone in the cystic duct or Hartmann’s pouch of the gallbladder. Classified as a rare case, it occurs in 0.7 to 1.8 percent of all cholecystectomies. Often not recognized preoperatively, in contains the risk to morbidity, biliary injury, and cancer. The original classification by McSherry described two types of Mirizzi syndrome i.e., type I – compression of the common hepatic duct or common bile duct by a stone impacted in the cystic duct C59 research buy or Hartmann’s pouch and type II – erosion of the calculus from the cystic duct into the common hepatic duct or common bile duct, producing a cholecystocholedochal fistula. Csendes classified into 4 types according to the presence and extent of cholecystobiliary fistula. Methods: Male, Mr. R, 22 years old, referred to RSCM to undergo therapeutic ERCP due to billiary stones found on previous MRCP. Since 1.5 years ago he complained of yellowish eyes accompanied with nausea, vomiting, and upper right colicky abdominal pain. He denied any bloody vomiting and black stool. He was then hospitalized in Gatot Soebroto Army Hospital and

soon diagnosed as having billiary-related disease and was underwent MRCP. Later stones were found and therapeutic ERCP was obliged to evacuate the stones, he was then referred to RSCM. On admission, he admitted increased yellowish eyes and decreased nausea and vomiting. Results: He has hypertension since 2 years ago and treated with Captopril. Icteric sclerae and hepatomegaly found. Increased bilirubin level, ALP, and yGT with MRCP findings of 1.5 cm impacted stone in cystic duct and 3 cm stone in gallbladder with dilatation of cystic and common hepatic ducts concurrent with cholangitis and cholecystitis. On ERCP this dilatation of common hepatic ducts were confirmed with concurrent dilatation of right and left hepatic ducts, plastic stent sized 7–9 was then placed and Mirizzi syndrome was then diagnosed and laparoscopic total cholecystectomy underwent.