Mirizzi Syndrome: Diagnosis and Management of a Challenging Biliary Disease

Abstract

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 cholecystectomy in 8 cases, bile duct repair over T-tube in 3 cases, and hepaticojejunostomy in 4 cases. Two cases (11.1%) of gallbladder cancer associated with the Mirizzi syndrome were incidentally found: a patient underwent right hepatectomy and another patient was unresectable. The overall morbidity rate was 16.6%. There was no postoperative mortality. An ERCP with stent insertion was required in three cases after surgery. Sixteen patients were asymptomatic at a mean distance of 24 months (range: 6-48) after surgery. Conclusions Mirizzi syndrome requires being treated by an experienced biliary surgeon after a careful assessment of the local situation and anatomy. The preoperative placement of a stent via ERCP can simplify the surgical procedure.

Endoscopic Nasogallbladder Drainage Combined with Laparoscopic Surgery for Type I Mirizzi Syndrome with Acute Cholecystitis: A Case Series Report

“…In 1991, Tamada et al (12) applied ENGBD to the treatment of acute cholecystitis. Similar reports were followed by Johlin and Neil (13) According to these reports, the success rate of ENGBD was 53.8-90.0% (5,13,15,16). An investigation reported by Masuda et al (17) revealed that the success rate of ENGBD in patients with no acute inflammation was 75.6% (90/119) and 71.0% (22/31) in patients with acute cholecystitis and Mirizzi syndrome, which was slightly low.…”

“…Because of the difficulty of preoperative diagnosis and the complexity of pathological changes in patients with Mirizzi syndrome, laparoscopic treatment for the disease is difficult and is associated with high risk for complications (4,5). It has been reported that patients with Mirizzi syndrome have a high rate of conversion from LC to open cholecystectomy (1).…”

Type III Mirizzi, successfully treated with a free gallbladder flap, a case report

“…Pablo Luis Mirizzi was one of the best biliary surgeons of the last century; he was the first surgeon to perform an intraoperative cholangiography successfully. Nonetheless, we usually recognize him by the syndrome that is named after him [ 1 , 2 ]. In 1948 he described the condition in with an impacted stone in the gallbladder infundibulum causes jaundice by extrinsic compression of the common bile duct [ 1 ].…”

“…Gallstone disease and its complications are among the most common surgical interventions worldwide; the arrival of better diagnostic and treatment modalities has improved patient outcomes [ [1] , [2] , [3] ]. Although gallstone disease is generally associated with cholecystitis, rare events such as Mirizzi syndrome can represent a challenge for the biliary surgeon, as they can significantly increase the risk of intraoperative biliary injury [ 3 ].…”

“…Although gallstone disease is generally associated with cholecystitis, rare events such as Mirizzi syndrome can represent a challenge for the biliary surgeon, as they can significantly increase the risk of intraoperative biliary injury [ 3 ]. Preoperative diagnosis, safe surgical techniques, and referring the patient to a specialized center can improve the patient's outcome and reduce troublesome complications [ 1 , 2 ]. We present the case of a 61-year-old patient, a type III Mirizzi syndrome was identified and successfully treated with a gallbladder free flap.…”