After sucessful endoscopic extraction of the impacted stone the patient remained free of symptoms without recurrent jaundice. In total, 16 case series and 11 case reports were identified and analyzed. The definitive diagnosis for these two rare internal fistulas was reached preoperatively, by ercp. Nov 27, 2014 mirizzi syndrome history, present and 1. Impacted stone in the cystic duct, cystic duct remnant, or gb neck. The surgical treatment of the mirizzi syndrome requires ability and care in the dissection of the biliary tract in order to perform the cholecystectomy, a safe operation of the biliary tract can be avoided and the removal of the calculus so can avoid any iatrogeny in the biliary tract, as in this particular case, where was opted to dissect the biliary tract incompletely through the torek. Cholelithiasis is commonly known as gallstone which directly means stone in the gallbladder. Patients with mirizzi syndrome can present with jaundice, fever, and right upper quadrant pain. Mirizzi syndrome is defined as common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder. At present, a standard treatment of mirizzi syndrome is not yet well defined, due to the heterogeneous clinical presentation.
Mirizzi and presents unusual lodged gallstone in either the cystic duct or most frequently in hartmann pouch of the gallbladder. Genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 toll free. Mirizzi s syndrome is a rare and chronic inflammation caused by a gallstone impacted in the hartmanns pouch with partial or complete obstruction of the main bile duct, which results in difficult. The mirizzi syndrome consists of the obstruction either of the common hepatic duct or the choledocus, secondary to the extrinsic compression due to the impact of calculus in the cystic duct or in the gallbladder infundibulum 4. The first description is due to pablo mirizzi 1948, when he observed some factors which could cause extra hepatic cholesthasis in certain groups of. Hiwa omer ahmed assistant professor in surgery mirizzi syndrome the stone ulcerating through into the cbd mirizzi s syndrome is a condition characterized by stricture of the common hepatic duct.
Sindrome mirizzi pdf 14 sep chronic complications of symptomatic gallstone disease, such as mirizzi syndrome, are rare in western developed countries with an incidence. In cases of intense inflammation, it is difficult to treat. Oct 17, 2018 mirizzi syndrome is an unusual presentation of obstructive jaundice caused by extrinsic compression of an extrahepatic biliary duct from one or more calculi within the cystic duct or gallbladder. Parital mechanical obstruction of the chd by compression of inflammatory reaction around an impacted stone will cause symptoms. Occasionally it may erode into the bile duct and cause a fistula between the gall bladder and the bi. The association of mirizzi syndrome and gallbladder carcinoma gbc is not well understood. Its mechanism is very similar to that of mirizzi syndrome, when the bile duct is compressed from outside due to a stone impacted in the gallbladder neck or cystic duct. Lai and wan yee lau department of surgery, prince of wales hospital, the chinese university of hong kong, shatin, new territories, hong kong background. The original classification by mcsherry and colleagues identifies 2 variants.
Mirizzi syndrome is a rare complication of gallstone disease gsd. Laparoscopic cholecystectomy lc, which has been used since. The purpose of this study is to retrospectively estimate the diagnostic and treatment methods applied in patients with mirizzi syndrome. Mirizzi syndrome ms is an uncommon complication of longterm chronic cholecystitis, characterized by extrinsic compression of the common hepatic duct or the presence of cholecystobiliary fistula. It is a functional hepatic syndrome but can often present with biliary duct dilatation and can mimic other hepatobiliary pathologies such as cholangiocarcinoma 2. A 75yearold man was admitted with the complaint of abdominal pain and jaundice.
Mirizzi syndrome is a rarely observed complication of gallstone disease, causing major biliary problems, if not diagnosed previously. Mirizzi s syndrome is a rare complication in which a gallstone becomes impacted in the cystic duct or neck of the gallbladder causing compression of the common hepatic duct, resulting in obstruction and jaundice. Factors that influence the results of treatment, archives of surgery, vol. The latest version of icd10 is updated each year on october 1. Mirizzi syndrome is an unusual benign condition resulting from a chronically impacted stone in the neck of the gallbladder that itself compresses the common bile duct or that over time induces sufficient pericholecystic inflammation to obstruct the adjacent common hepatic duct or common bile duct. Mirizzi syndrome is a rare cause of obstructive jaundice.
Mirizzis syndrome masquerading as cholangiocarcinoma. Mirizzis syndrome is a rarely observed disorder that presents with obstructive jaundice. Mirizzi, pl definition of mirizzi, pl by medical dictionary. Apr 05, 2020 mirizzi syndrome is a rare complication of gallstone disease. The mirizzi syndrome is an unusual presentation of gallstones which occurs when a gallstone becomes impacted in either hartmanns pouch of the gallbladder or the cystic duct, causing obstruction of the common hepatic duct by extrinsic compression. Mirizzis syndrome treatment in india diagnosis of mirizzi. Mirizzi syndrome, known as extrinsic bile compression syndrome, is a rare complication of cholecystitis and chronic cholelithiasis, secondary to the obliteration of the infundibulum of the gallbladder or cystic duct caused by the impact of one or more calculations in these anatomical structures, which leads to compression of the adjacent bile duct, resulting in partial or complete.
Surgical treatment of patients with mirizzi syndrome requires. Ultrasonography us, ct, and magnetic resonance cholangiopancreatography mrcp are common initial tests for suspected mirizzi syndrome. Mirizzi syndrome is a rare complication of long standing cholelithiasis which occurs in 0. Mirizzi syndrome is an unusual presentation of obstructive jaundice caused by extrinsic compression of an extrahepatic biliary duct from one or more calculi within the cystic duct or gallbladder. Pdf mirizzi syndrome is a rare cause of obstructive jaundice. Mirizzi ii 9 patients cholecystectomy with plastics of fistula, in 6 external drainage of. Mirizzis syndrome is a health condition that involves an obstruction of the common hepatic duct or the common bile duct, as an end result of an extrinsic compression by an impacted stone which is located in the cystic duct, or in the hartmanns pouch found in the gallbladder. Mirizzi syndrome type iv associated with cholecystocolic. A stone in the gall bladder sometimes can compress the common bile duct and cause jaundice. This file is licensed under the creative commons attribution 2. Our experience with 27 cases with mirizzi syndrome is presented.
However, recent advances in technology have provided surgeons with new options for more effective diagnosis and treatment of this condition. The diagnosis of this syndrome is of importance because surgery in its presence is associated with an increased incidence of bile duct injury. Mirizzi syndrome ms is a rare cause of benign obstructive jaundice triggered by impacted calculus in hartmann bag or cystic duct, causing extrinsic obstruction of the common hepatic duct. We present a case of a patient who underwent open rather than coelioscopic cholecystectomy based upon the preoperative diagnosis of mirizzi s syndrome. It is more common in females between 21 to 90 years old 1. Definition of mirizzi, pl in the medical dictionary by the free dictionary. Mirizzi syndrome is a rare complication of chronic cholecystitis that can lead to obstructive.
This occurrence is rare and, in english literature, three cases defined in children have been observed. Although mirizzi syndrome is a wellknown complication of gallstones, an accurate preoperative diagnosis is often difficult, as illustrated in this case. Mirizzi syndrome or extrinsic biliary compression syndrome, is a rare complication of cholelithiasis. We report our experience of gallbladder carcinoma in patients with mirizzi syndrome. Mirizzis syndrome may be mistaken for pancreatic cancer or cholangiocarcinoma p. Todorov 3, 1 fellow, masters program in hepatobiliary pancreatic surgery, henri bismuth hepatobiliary institute, 1214, avenue paul vaillantcouturier, 94804 villejuif cedex. Feb 14, 2019 mirizzi syndrome is defined as common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder. The resulting bile retention is sometimes mistakenly attributed to involvement of. In order to draw attention to this rare occurrence, we preferred a 14yearold male patient with mirizzi syndrome. Jump to navigation jump to search this is an alphabeticallysorted.
An uncommon complication of cholelithiasis, mirizzi s syndrome should be included in the differential diagnosis of any patient who has extrahepatic biliary obstruction. Posts about mirizzi syndrome written by simply radiology. The mirizzi syndrome refers to an uncommon phenomenon which results in extrinsic compression of an extrahepatic biliary duct from one or more calculi within the cystic duct or gallbladder. Mirizzi syndrome, known as extrinsic bile compression syndrome, is a rare complication of cholecystitis and chronic cholelithiasis secondary to obliteration of the infundibulum of the gallbladder hartmanns pouch or cystic duct caused by the impact of one or more calculations in these anatomical structures. Pubmed is a searchable database of medical literature and lists journal articles that discuss mirizzi syndrome.
Mirizzi s syndrome is a rare complication in which a gallstone becomes impacted in the cystic duct or neck of the gallbladder causing compression of the cbd common bile duct, resulting in cbd obstruction and jaundice. It is a functional hepatic syndrome but can often present with biliary duct dilatation and can mimic other hepatobiliary pathologies such as. Introduction refers to common hepatic duct obstruction caused by an extrinsic compression from an impacted stone in the cystic duct or hartmanns pouch of the gallbladder occurs in approximately 0. Preoperative diagnosis may be difficult despite the availability of multiple imaging modalities. Mirizzi syndrome definition of mirizzi syndrome by. The patient was accepted as ms type iii according to radiological imaging and intraoperative view. Mirizzi syndrome a difficult condition to diagnose. Mirizzi syndrome is an important complication of gallstone disease. Surgery remains the preferred approach for the treatment of mirizzi syndrome. Current trends in the management of mirizzi syndrome. Acute acalculous cholecystitis complicated by mrcp.
The condition is often confused with other serious conditions such as hilar cholangiocarcinoma, which present with similar. The surgical treatment of mirizzi syndrome requires. The diagnostic features on ultrasound are dilatation of the intra and extrahepatic bile ducts to the origin of the cystic duct or the neck of the gallbladder, were a gallstone can be found. They were diagnosed either by imaging techniques, or during surgical operation.
Laparoscopic treatment of type iii mirizzi syndrome by ttube. Mirizzis syndrome treatment, classification, symptoms, types. Laparoscopic treatment of type iii mirizzi syndrome by t. Mirizzi s syndrome may be mistaken for pancreatic cancer or cholangiocarcinoma p. We would like to report laparoscopic treatment of type iii ms. The obstructive jaundice can be caused by direct extrinsic compression by the stone or from fibrosis caused by chronic cholecystitis inflammation. Mirizzi syndrome is a rare complication of long standing cholelithiasis.
Mirizzi syndrome is an unusual presentation of obstructive jaundice. If not recognized preoperatively, it can result in significant morbidity and mortality. A case of type iv ms, with extensively damaged common hepatic duct chd due to gallstone impaction and fistula, was effectively treated by minilaparoscopic hepaticoduodenostomy hd. In type ia, fundusfirst cholecystectomy with simple closure of cystic duct while in type ib choledochoplasty. For patients who are highrisk surgical candidates, gallbladder wall free flap. In choledochoplasty, we the utilize a pedicled graft of gallbladder remnant in treatment of mirizzis syndrome 8, 9.
Mirizzis syndrome is a rare condition complicating gall stone disease. Mirizzi syndrome medigoo health medical tests and free. Contrast directly passes from biliary tree into gb mr. The patient may present initially with colicky epigastric pain or manifest with. All structured data from the file and property namespaces is available under the creative commons cc0 license. Click on the link to view a sample search on this topic. Mirizzi syndrome is a rare complication frequency about 1% of chronic cholecystitis and prolonged cholelithiasis, which consists of inflammatory process of gallbladder wall and direct compression mirizzi syndrome type i or erosion mirizzi syndrome type ii, iii, iv of the common bile duct and subsequent fistulous formation.
Mirizzi syndrome and gallbladder cancer springerlink. Mirizzi syndrome is a rare complication of gallstone disease. About 1 items found relating to mirizzi s syndrome. The mirizzi syndrome is an unusual presentation of gallstones which occurs when.
Mirizzi syndrome is the compressive blockage of the cystic or choledochal duct caused by a biliary stone occupying the cystic canal or hartmanns pouch. If you have problems viewing pdf files, download the latest version of adobe reader. Mirizzi syndrome is important to surgeons because preoperative diagnosis is not always possible. Mirizzi syndrome type vb is a matter of controversy, nonetheless, it seems advisable to treat the acute condition first gallstone ileus and at a second time after the patient has recovered from surgery 3 or more months later, approach the gallbladder according to the presence or absence of external compression of the bile duct or. You may do so in any reasonable manner, but not in any way that. Mirizzi syndrome ms is an impacted stone in the cystic duct or hartmanns pouch that mechanically obstructs the common bile duct. Mirizzi described an unusual presentation of gallstones which, when lodged in either the cystic duct or the hartmann pouch of the gallbladder, externally compressed the common hepatic duct chd, causing symptoms of obstructive. The condition is caused by a stone impacted in the gall bladder neck or cystic duct that impinges on the common hepatic duct, with or without a cholecystocholedochal fistula.
When a gallstone blocks the common hepatic duct, thereby preventing bile from draining out of the liver, jaundice may develop. This entity should be considered in the d i ff e rential diagnosis of all patients with obstru c t i v e jaundice. In rare cases mirizzi syndrome without cholecystolithiasis can cause biliary symptoms. Mirizzi syndrome can be divided into several types depending on the presence or absence of fistula and the size of the fistula. Mirizzi s syndrome management this involves cholecystectomy plus common bile duct exploration with ttube placement. The clinical presentation, the preoperative radiological investigations and even the intraoperative findings can all mimic hilar cholangiocarcinoma, or carcinoma of the gallbladder 4, 5. Mirizzi syndrome ms in association with biliaryenteric fistula is an extremely rare combination. Mirizzi syndrome, known as extrinsic bile compression syndrome, is a rare complication of cholecystitis and chronic cholelithiasis, secondary to the obliteration of the infundibulum of the gallbladder or cystic duct caused by the impact of one or more calculations in these anatomical structures, which leads to compression of the adjacent bile duct, resulting in partial or complete obstruction.
Files are available under licenses specified on their description page. Management this involves suture of the fistula with absorbable material or choledochoplasty with the remnant gallbladder. Occasionally it may erode into the bile duct and cause a fistula between the gall bladder and the bile duct. Current trends in the management of mirizzi syndrome ncbi. Mirizzi has emphasised that obstructive symptoms of the hepatic duct may occur as a result of spasm, inflammatory process, or other local organic lesion. For language access assistance, contact the ncats public information officer. Mirizzi syndrome definition of mirizzi syndrome by medical. Jan 26, 2018 mirizzi syndrome is a rare and challenging clinical entity to manage. Impression on chd is often concave to the right cholecystocholedochal fistula. Mirizzi syndrome genetic and rare diseases information. An online search language was performed using pubmed and web of science for literature published in english between 2012 and 2017 using the search terms mirizzi syndrome and mirizzi. The patient may present initially with colicky epigastric pain or manifest with hyperbilirubinemia jaundice. Abstract introduction acute acalculous cholecystitis can be complicated by extrinsic compression of the common hepaticcommon bile duct by the enlarged and inflamed gallbladder followed by jaundice. Mirizzi s syndrome is a rare condition complicating gall stone disease.
To our knowledge there is only one report that refers to the rare coexistence of mirizzi syndrome type ii with a parapapillary choledochoduodenal fistula. Mirizzis syndrome an overview sciencedirect topics. Mirizzi syndrome is a rare complication of gallstone disease in which a gallstone becomes impacted in the cystic duct or neck of the gallbladder causing compression of the common bile duct cbd or common hepatic duct, resulting in proximal obstruction. Minimally invasive treatment of mirizzi syndrome, a rare. The most frequently used diagnostic modalities were ultrasound, computed tomography ct.
249 1329 228 460 74 471 789 43 66 5 542 254 817 318 641 129 245 473 1539 1613 1354 516 402 1005 1390 225 950 124 65 871 259