Le syndrome de Mirizzi: une cause rare de l’obstruction des voies biliaires: à propos d’un cas et revue de littérature

Abstract

Le syndrome de Mirizzi est une complication rare de la lithiase vésiculaire chronique, avec une incidence de 0,7% à 1,4% chez les malades cholécystéctomisés. Il est caractérisé par un ictère cholestatique en rapport avec une compression de la voie biliaire principale par un calcul enclavé dans le collet vésiculaire ou le canal cystique. La maladie peut évoluer vers l’érosion de la paroi du canal hépatique commun et par conséquent, provoquer la formation d’une fistule cholécysto-bilaire. Nous présentons ici un syndrome de Mirizzi type I en soulignant l’importance du diagnostic préopératoire, celui-ci étant rendu plus aisé par la cholangiographie rétrograde endoscopique ou par la cholangio-IRM, qui permet d’éviter des lésions iatrogènes de la voie biliaire principale. Le présent article passe en revue la littérature disponible sur les divers aspects de ce syndrome, y compris sa pathogenèse, son diagnostic et sa prise en charge.

Evaluating the Surgical Treatment of Mechanical Icterus in the General Surgery Department of the Hopital Ntional Ignace Deen, Chu De Conkry

“…Exposure to risk factors such as tobacco and alcohol are common during this period of life, and are responsible for the early onset of tumours, particularly those of the head of the pancreas. This is not the case for lithiasis of the main bile duct, where the data in the literature are in line with those found in our series [7,10].…”

“…The predominance of young adult males reported in the literature was found in our series [7,6,2,8]. Exposure to risk factors such as tobacco and alcohol are common during this period of life, and are responsible for the early onset of tumours, particularly those of the head of the pancreas.…”

“…Diagnosis was made by ultrasonography, still considered in countries like ours as the first-line examination performed in all our patients [7,9]. The lack of CT scans is thought to be due to the high cost in relation to the population's income.…”

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“…Mirizzi syndrome was first described by KEHR in 1905, taken up by MIRIZZI in Argentina, describing complete or partial obstruction of the hepatic duct by calculus locked in cystic with acute or chronic inflammation [13]. It is a rare situation representing only 0.05 to 4% of all patients operated on for gallstones [14]. Of purely mechanical physio pathological mechanism, there are certain anatomical conditions that may favor the occurrence of this complication of vesicular lithiasis, such as a very high or very low cystico-choledochal contact located or a parallel course of the common hepatic duct and the cystic duct forming the picture in rifle barrel.…”

“…Of purely mechanical physio pathological mechanism, there are certain anatomical conditions that may favor the occurrence of this complication of vesicular lithiasis, such as a very high or very low cystico-choledochal contact located or a parallel course of the common hepatic duct and the cystic duct forming the picture in rifle barrel. it can be associated with a bilio-biliary fistula secondary to erosion of the main bile duct by landlocked calculus, imposing its closure in per-action [14].…”