Mirizzi's Syndrome: Identification and Management Strategy

Abstract

Fourteen cases of Mirizzi's syndrome are presented here. Clinical presentation was pain (14), jaundice (14), fever (10) and peritonitis (1). A clinical diagnosis of choledocholithiasis was considered in all the patients. Pre‐operative diagnosis of Mirizzi's syndrome was made in five patients on the basis of cholangiogram and the remaining cases were diagnosed at surgery. The stage (type) of Mirizzi's syndrome was based on the extent of erosion of the common bile duct. Four patients had type I, seven type II and three type III lesions. Associated choledocholithiasis was present in five and acute free perforation of the gall‐bladder in one. The operative procedures performed were partial cholecystectomy for type I, partial cholecystectomy, choledochoplasty and T‐tube choledochostomy for type II and bilioenteric anastomosis for type III lesions. Two patients had retained common bile duct stones. Mean follow up was 14 months (range 1–27 months). One patient with secondary biliary cirrhosis continues to have persistently elevated serum alkaline phosphatase levels without any demonstrable biliary obstruction. Diagnostic and operative strategies are discussed and a follow up protocol for such patients is suggested.

Management of Mirizzi's syndrome in the laparoscopic era

“…T-tube cholangiography was performed on an outpatient basis, and the T tube was removed on the 14 postoperative day. The mean follow-up period was 12 (range, [8][9][10][11][12][13][14][15][16][17] months, and all the patients remained asymptomatic.…”

“…The operative options are similar to those recommended for open cholecystectomy [8,9]. For patients with acute cholecystitis, we decompress the gallbladder initially.…”

Mirizzi Syndrome—Two Case Reports and a Short Review of the Literature

“…In surgical practice there is only one benchmark for this syndrome: whether or not there exists any kind of biliary fistula, 17 either cholecystocholedochal or cholecystohepatic. The fistula diagnosis 18,19 is the important step, but the appropriate treatment is the most important part of MS. In the nineteenth and the first half of the twentieth centuries, the gold standard in biliary reconstruction was a very conservative approach-choledochoplasty plus T-tube drainage-but now it is preferable to perform hepaticojejunostomy as the most convenient operation.…”

Manejo cirúrgico da síndrome de Mirizzi

“…A icterícia e a dor abdominal podem ocorrer em 60 a 100% dos pacientes 10,11 . A ultrassonografia do abdome deve ser usada na triagem inicial e algumas vezes pode mostrar achados típicos de síndrome de Mirizzi, como cálculo grande imóvel no infundíbulo da vesícula biliar e dilatação do ducto biliar acima da obstrução mas normal abaixo dela 3,4 .…”