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We report the first case of Mirizzi syndrome in a patient who presented with biliary obstruction caused by pure calcium carbonate stones. A 61 years old male with history of portal vein thrombosis presented with rash, nausea and jaundice. An ultrasound of biliary tree showed gallstones with dilatation of hepatic duct and intrahepatic biliary tree. There was suspicion of a stone in proximal CBD. CT scan showed an opaque gallbladder with dense radio-opaque material in its lumen. An ERCP was then performed revealing external common hepatic duct obstruction at the neck of the gallbladder. A plastic biliary stent was placed across the obstruction, followed by a cholecystectomy. Resected gallbladder specimen revealed thick whitish paste like material, and formed stones filling the gallbladder lumen. Laboratory testing showed this material to be composed of 100% calcium carbonate crystals.

Background: There are indications that many women prefer female health care providers., Objective: To determine whether (1) patients and health care professionals have sex preferences for gastroenterologists (for office visit and colonoscopy) and (2) the reasons behind these preferences., Design: Prospective survey., Setting: Patients from primary care clinics at a Veterans Affairs and a community hospital and health care professionals., Patients: A total of 1364 individuals completed the survey: 840 patients (566 men and 274 women) and 524 health care professionals (211 men and 313 women)., Main Outcome Measurements: Sex preferences for colonoscopists and gastroenterologists at a clinic., Results: Women had a stronger sex preference (compared with no preference) for an office visit with a gastroenterologist (44.3%) and for a colonoscopist (53%) than men (23% and 27.8% respectively; P < .001). For health care professionals, there was a significant difference in sex preferences for women and men for a gastroenterologist office visit (30.4% vs 17.6%; P < .001) and for a colonoscopist (43.1% vs 26.1%; P < .001). Of all respondents with a sex preference, the most common reason was embarrassment for both office visit and colonoscopy. For all respondents with a sex preference for colonoscopy, a higher level of education was an independent predictor of patients feeling embarrassed (P = .003)., Limitations: Single city, patient population from only 2 institutions., Conclusions: Female patients and female health care professionals have sex preferences in choosing a gastroenterologist for an office visit and colonoscopy, and the reasons for this are significantly influenced by their level of education., (Copyright © 2011. Published by Mosby, Inc.)