A Retrospective Review of the Diagnostic and Management Challenges of Mirizzi Syndrome at the Singapore General Hospital

Seah, Wei Ming; Koh, Ye‐Xin; Cheow, Peng Chung; Chow, Pierce K. H.; Chan, Chung Yip; Lee, Ser Yee; Ooi, London L P J; Chung, Alexander Y. F.; Goh, Brian K. P.

doi:10.1159/000484256

Cited by 9 publications

(20 citation statements)

References 16 publications

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“…Mirizzi syndrome (MS) is an uncommon phenomenon, with an incidence of 0.7-2.9% of all cholecystectomies (2,4,5). Pablo Luis Mirizzi first described this entity in 1948, defining it as an obstruction of the common hepatic duct (CHD) or common bile duct (CBD) by the compression of an impacted stone in the neck of the gallbladder or cystic duct, causing obstructive jaundice, and leading occasionally to fistulization to the bile duct or surrounding organs (6,7).…”

Section: Introductionmentioning

confidence: 99%

Mirizzi syndrome from type I to Vb: a single center experience

2020

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Objective: The present study describes a cohort of patients diagnosed with Mirizzi syndrome from type I to Vb, over a period of four years. It aimed to identify diagnostic and management pitfalls of Mirizzi syndrome, as well as their concomitant cholecystobiliary or cholecystoenteric fistulas. Material and Methods:We retrospectively reviewed all electronic medical records of patients who underwent surgery for Mirizzi syndrome at a single institution.Results: Twenty-two patients (0.6%) were diagnosed with Mirizzi syndrome. Most of the patients were females (n=19, 86.3%). Mean age was 43.8 years (range: 21-71 years). Ultrasound was performed in all (100%) patients. Six (27.2%) patients had a CT scan and six (27.2%) patients had endoscopic retrograde cholangiopancreatography. Overall preoperative diagnosis was achieved on 36.6% (n=8) of the patients. There were the same total and partial cholecystectomies, accounting for ten (45.5%) cases each, one hepaticojejunostomy with cholecystectomy (4.5%), and one enterolithotomy (4.5%). Laparoscopic cholecystectomy was attempted in 15 (68.1%) patients, with conversion to open surgery in 93.3% (n=14) of the patients. An open approach was made in five (22.7%) cases. Four (18.1%) patients were reported as MS type I, both types II and III each account for 22.7% (n=5) of the cases, there was only one (4.5%) patient with type IV, and seven (31.8%) patients with type V. Conclusion:There are limited studies of patients with Mirizzi syndrome, including type V classification, and when this syndrome is suspected, a preoperative diagnosis should be made to avoid bile duct injuries or lesions to adjacent organs.

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Section: Introductionmentioning

confidence: 99%

Mirizzi syndrome from type I to Vb: a single center experience

2020

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“…According to the original papers, the most common symptoms were abdominal pain (incidence 65.7-100%) and jaundice (ranging between 45-87.5%). Other symptoms were nausea and vomiting (31-62%), cholangitis (up to 56%), fever (21-42%) and anorexia (11-29.2%) [6,7,[28][29][30][31][32]. Furthermore, Shirah et al reported that there was a positive Murphy's sign in 50% of their patients during physical examination [6].…”

Section: Symptoms and Laboratory Resultsmentioning

confidence: 99%

The Current Approach to the Diagnosis and Classification of Mirizzi Syndrome

et al. 2021

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Mirizzi syndrome occurs in up to 6% of patients with cholecystolithiasis. It is generally caused by external compression of the common hepatic duct by a gallstone impacted in the neck of the gallbladder or the cystic duct, which can lead to fistulisation. The aim of this review was to highlight the proposed classifications for Mirizzi syndrome (MS) and to provide an update on modern approaches to the diagnosis of this disease. We conducted research on various internet databases and the total number of records was 993, but after a gradual process of elimination our final review consisted of 21 articles. According to the literature, the Cesendes classification is the most commonly used, but many new suggestions have appeared. Our review shows that the ultrasonography (US) is the most frequently used method of initial diagnosis, despite still having only average sensitivity. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) are good methods and are similarly effective, but only the latter can be simultaneously therapeutic. Some modern methods show very high sensitivity, but are not so commonly administered. Mirizzi syndrome is still a diagnostic challenge, despite the advancement of the available tools. Preoperative diagnosis is crucial to avoid complications during treatment. New research may bring a unification of classifications and diagnostic algorithms.

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“…CT scan is useful in differentiating Mirizzi syndrome from a malignancy, especially when a cholecystobiliary fistula is present [14]. Pre-operative diagnosis improves outcomes of surgery, allowing better planning [5,6,8,[27][28][29] and referral to the appropriate surgeon. If pre-operative diagnosis is not achieved, intra-operative recognition and proper management are essential to improve outcomes, reduce morbidity (up to 17% bile duct injury) and mortality [5,13].…”

Section: Discussionmentioning

confidence: 99%

“…The traditional approach for type II Mirizzi syndrome included a subtotal cholecystectomy leaving a 10 mm flap of gallbladder around the fistula for the reconstruction of the destroyed bile duct protected by a T-Tube to avoid post-operative strictures or bile leakages. In cases with large defects (> 50% of the circumference of the CBD) when the surrounding tissues cannot be recruited to reconstruct the CBD bilioenteric anastomosis may be required [3,5,28] (Fig. 3).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic management of type II Mirizzi syndrome

et al. 2020

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Background Mirizzi syndrome is an uncommon complication of longstanding gallstone disease. Pre-operative diagnosis is challenging, and to date, there is no consensus on the standard management for this condition. Until recently open cholecystectomy was the standard of care for type II Mirizzi syndrome (McSherry classification). The objective of this study was to assess the incidence and management of type II Mirizzi syndrome in patients with proven or suspected choledocholithiasis undergoing laparoscopic common bile duct (CBD) exploration and present our experience in the laparoscopic management of this rare condition over the last 21 years. Methods Prospective data collection of eleven cases of type II Mirizzi syndrome amongst a series of 425 laparoscopic bile duct explorations was performed between 1998 and 2019. Demographic, clinical, diagnostic, intra-operative, and postoperative data were recorded. Results The incidence of type II Mirizzi syndrome was 2.6% in 425 laparoscopic CBD explorations. All operations were completed laparoscopically with closure of the defect over a decompressed CBD (T-tube n = 3, antegrade stent n = 5, transcystic drain n = 2), and in one case a non-drained duct was closed with Endoloop. Stone clearance rate was 100% (11 cases). In two patients the transinfundibular approach was used in conjunction with holmium laser lithotripsy to enable choledochoscopy and successful stone clearance. Three patients were complicated in the post-operative period with bile leak (n = 2) and lower respiratory tract infection (n = 1). An incidental gallbladder carcinoma was found in one patient. Conclusion Laparoscopic management of type II Mirizzi syndrome is feasible and safe when performed by experienced laparoscopic foregut surgeons. Laparoscopy and choledochoscopy can be combined with novel approaches and techniques to increase the likelihood of treatment success.

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A Retrospective Review of the Diagnostic and Management Challenges of Mirizzi Syndrome at the Singapore General Hospital

Cited by 9 publications

References 16 publications

Mirizzi syndrome from type I to Vb: a single center experience

Mirizzi syndrome from type I to Vb: a single center experience

The Current Approach to the Diagnosis and Classification of Mirizzi Syndrome

Laparoscopic management of type II Mirizzi syndrome

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