Mirizzi Syndrome: A Case Report (original) (raw)
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Mirizzi Syndrome: An Unusual Complication of Cholelithiasis
Journal of Community Hospital Internal Medicine Perspectives, 2022
Mirizzi syndrome is a rare condition caused by the obstruction of the common bile duct or common hepatic duct by external compression from multiple impacted gallstones or a single large impacted gallstone in Hartman's pouch. The condition can easily be confused with choledocholithiasis, bile duct stricture or cholangiocarcinoma due to the presence of obstructive jaundice hence may be overlooked due to the rarity of the condition. The incidence of Mirizzi syndrome among patients with gallstones is reported to range from 0.63 to 5.7%. Furthermore, it poses a differential diagnosis dilemma for the physician as well as radiologists because there are no clinical features or diagnostic procedures that have a 100% specificity and sensitivity. Laparotomy is the preferred surgical technique of choice. For the patients who are poor surgical candidate, mainstay of treatment is biliary stent placement for the restoration of normal biliary drainage. Due to low incidence of the Mirizzi syndrome, an elevated index of suspicion is required to diagnose this condition. At present, there are no well-developed, internationally recognized clinical guidelines for the management of this syndrome. Furthermore, the diagnostic procedures available still pose a barrier in the ability to confirm the diagnosis prior to surgical treatment, even though the diagnostic rate has increased dramatically.
Mirizzi syndrome, an uncommon complication of cholelithiasis
IP Innovative Publication Pvt. Ltd., 2017
We hereby describe a case of 38 years old young man, known diabetic and alcoholic, presenting with history of pain in right hypochondriam, fever and progressive jaundice. His investigations revealed marked derangement of liver functions with predominant conjugated hyperbilirubinemia and raised alkaline phosphatase suggestive of obstructive jaundice. Subsequent investigation by ultrasound and magnetic resonance cholangiopancreatography (MRCP), revealed a large stone in the cystic duct compressing the common bile duct with intrahepatic biliary radical dilatation, suggesting the rare diagnosis of Mirizzi Syndrome. In the present report the authors will discuss the importance of recognizing this relatively rare entity, its classification and management related issues.
Mirizzi syndrome-rare cause of major biliary complications. /Case Report/
Journal of IMAB - Annual Proceeding (Scientific Papers), 2010
Mirizzi syndrome is a rarely observed complication of gallstone disease, causing major biliary problems, if not diagnosed previously. It was described in 1948 by P. L. Mirizzi and presents unusual lodged gallstone in either the cystic duct or most frequently in Hartmann pouch of the gallbladder. Impaction, acute obstruction and wall ischemia are causative for inflammation and abscess formation. External common hepatic bile duct compression and obstruction result in clinical presentation of intermittent or constant jaundice. We report 57-year-old male with extensive mechanical icter, fever, nausea and vomiting, and upper abdominal pain in epigastria from five days. Abdominal US evaluation showed 17mm stone localized in infundibulum and shrunk of gallbladder. MRCT revealed impacted stone, chronic tissue inflammation, involved common hepatic duct with stricture. Mirizzi syndrome was diagnosed. Intraoperatively was found an impacted gallstone in the Hartmann pouch, extensive fibrosis of hepatoduodenal ligament and abscess cavity formation in the Callot's triangle with engagement of common hepatic bile duct wall. Antegrade cholecystectomy was made and T drain was placed. Second operation and Roux-Y limb anastomosis was performed after unsuccessful tentative for recanalization of distal CBD with clamping of T drain.
Mirizzi syndrome type a: A rare coexistence of double cholecysto-biliary and
2010
Mirizzi syndrome is a rare cause of intermittent obstructive jaundice, where an impacted stone in the cystic duct or Hartmann's pouch mechanically obstructs the common bile duct (CBD). We report a rare case of double cholecysto-biliary and cholecysto-enteric fistulae, in a 75-year-old female patient, presenting with a right upper quadrant abdominal pain and intermittent obstructive jaundice. Endoscopic retrograde cholangiopancreatography suggested Mirizzi syndrome. Operative findings included erosions of the lateral wall of the CBD and the second portion of the duodenum due to impacted gallstones. The defects were reconstructed primarily and a Kehr tube was inserted. The patient had an uneventful postoperative course and was discharged on the 14th postoperative day.
Cholelithiasis Secondary to Mirizzi Syndrome: An Overview
2023
Mirizzi syndrome (MS) is a relatively rare condition, accounting for a small percentage of biliary disorders. Even though this complication of cholelithiasis has a low prevalence, its morbidity rates, reflecting the overall burden of the disease, have been reported to range from 10% to 50%. This narrative review aims to provide a comprehensive overview of this rare but potentially complex condition, including its epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment options. Surgical options for MS include open surgical procedures and minimally invasive approaches. Laparotomy, despite its more invasive nature, high complication rate, and extended postoperative hospital stay, has been considered the technique of choice, mainly due to its relative safety compared with the laparoscopic technique, the advantage of better visualization, haptic feedback, and removal of gallbladder calculus before cholecystectomy. Subtotal cholecystectomy may be the best treatment for Mirizzi type I and most cases of type II and III. Recently, subtotal cholecystectomy has been described as laparoscopic cholecystectomy, following the exact technical details described for the open technique. Laparoscopic cholecystectomy in MS showed high conversion levels (31% to 100%), complication rates of zero to 60%, biliary damage rates of zero to 22%, and mortality ranging from zero to 25%. This modality is expected to become more secure with technical advances, new materials, and greater surgeon experience. However, the conventional approach is still the gold standard.
Mirizzi Syndrome: Diagnosis and Management of a Challenging Biliary Disease
Canadian Journal of Gastroenterology and Hepatology, 2018
Background. Mirizzi syndrome is a condition difficult to diagnose and treat, representing a particular “challenge” for the biliary surgeon. The disease can mimic cancer of the gallbladder, causing considerable diagnostic difficulties. Furthermore, it increases the risk of intraoperative biliary injury during cholecystectomy. The aim of this study is to point out some particular aspects of diagnosis and treatment of this condition. Methods. The clinical records of patients with Mirizzi syndrome, treated in the last five years, were reviewed. Clinical data, cholangiograms, preoperative diagnosis, operative procedures, and early and late results were examined. Results. Eighteen consecutive patients were treated in the last five years. Presenting symptoms were jaundice, pain, and cholangitis. Preoperative diagnosis of Mirizzi syndrome was achieved in 11 patients, while 6 had a diagnosis of gallbladder cancer and 1 of Klatskin tumor. Seventeen patients underwent surgery, including cholec...
BMC Surgery, 2007
Background: Mirizzi syndrome is a rare complication of prolonged cholelithiasis with presence of large, impacted gallstone into the Hartman's pouch, causing chronic extrinsic compression of common bile duct (CBD). Fistula formation between the CBD and the gallbladder may represent an outcome of that condition. According to Mirizzi's classification and Csendes's subclassification, Mirizzi syndrome type IV represents the most uncommon type (4%).
World journal of radiology, 2010
Mirizzi syndrome is a rare cause of intermittent obstructive jaundice, where an impacted stone in the cystic duct or Hartmann's pouch mechanically obstructs the common bile duct (CBD). We report a rare case of double cholecysto-biliary and cholecysto-enteric fistulae, in a 75-year-old female patient, presenting with a right upper quadrant abdominal pain and intermittent obstructive jaundice. Endoscopic retrograde cholangiopancreatography suggested Mirizzi syndrome. Operative findings included erosions of the lateral wall of the CBD and the second portion of the duodenum due to impacted gallstones. The defects were reconstructed primarily and a Kehr tube was inserted. The patient had an uneventful postoperative course and was discharged on the 14th postoperative day.
Mirizzi Syndrome: an unexpected problem of cholelithiasis. Our experience with 27 cases
International Seminars in Surgical Oncology, 2008
Purpose: Mirizzi syndrome is a rare complication of long standing cholelithiasis. The purpose of this study is to retrospectively estimate the diagnostic and treatment methods applied in patients with Mirizzi syndrome. Materials and methods: Our experience with 27 cases with Mirizzi syndrome is presented. They were diagnosed either by imaging techniques, or during surgical operation. All of the patients were managed surgically. Results: 8 patients were diagnosed preoperatively and the rest intraoperatively. Morbidity rate after surgery was 18,5%, and mortality rate was zero. The patients presented free of symptoms three months after surgery during the follow-up. Conclusion: Mirizzi syndrome is rarely diagnosed preoperatively and US proved inadequate for this purpose. Surgery is the only therapy and usually provides additionally definitive diagnosis.
Unusual Case of Mirizzi Syndrome Presenting as Painless Jaundice
American Journal of Case Reports, 2022
Patient: Male, 60-year-old Final Diagnosis: Mirizzi syndrome Symptoms: Dark stools • jaundice • painless jaundice Medication: — Clinical Procedure: ERCP with stent placement • spyglass cholangioscopy Specialty: Gastroenterology and Hepatology Objective: Unusual clinical course Background:Isolated painless jaundice is an uncommon presenting sign for Mirizzi syndrome, which is typically characterized by symptoms of acute or chronic cholecystitis. We report a rare case of Mirizzi syndrome with an acute onset of painless obstructive jaundice.Case Report:A 60-year-old man with an unremarkable prior medical history presented with 1 week of jaundice, dark urine, and acholic stools. His laboratory studies revealed a pattern of cholestasis with marked direct hyperbilirubinemia. Ultrasound and magnetic resonance imaging studies demonstrated intrahepatic ductal dilation and cholelithiasis, including a stone within the cystic duct. Endoscopic retrograde cholangiopancreatography with SpyGlass cholangioscopy confirmed the diagnosis of Mirizzi syndrome.Conclusions:An atypical presentation of Mirizzi syndrome should be suspected in the setting of biliary obstruction without pain. The differential diagnosis is broad and includes choledocholithiasis, ascending cholangitis, and hepatobiliary malignancy. Evaluation should include laboratory studies and biliary tract imaging. Noninvasive biliary tract imaging can help exclude malignancy and confirm ductal dilation but is not sensitive for Mirizzi syndrome. Endoscopic retrograde cholangiopancreatography can serve both diagnostic as well as therapeutic purposes via stone extraction and stent placement. SpyGlass cholangioscopy can also augment management in the form of Electrohydraulic lithotripsy. Although therapeutic biliary endoscopy can be very effective, cholecystectomy remains the definitive treatment for Mirizzi syndrome.