Mirizzi Syndrome: Diagnosis, Treatment and a Plea for a Simplified Classification

Solis-Caxaj, César A.

doi:10.1007/s00268-009-9929-1

Cited by 11 publications

(6 citation statements)

References 13 publications

(9 reference statements)

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“…As in other biliary diseases, ultrasound is the first-line diagnostic test, with sensitivity varying from 8.3% to 62.7%15 (50% in our series). Ultrasound identifies various characteristic features of Mirizzi syndrome, such as presence of a small gallbladder, with thin walls containing one or multiple gallstones in the infundibulum, and dilatation of the intra- and extrahepatic bile ducts to the level of the obstruction.…”

Section: Discussionsupporting

confidence: 50%

“…A fifth type was added in 2007, which refers to any other type of Mirizzi syndrome associated with cholecystoenteric fistula (CEF) 81213. Finally, in 2012, Beltrán14 established a new classification based on a suggestion by Solis-Caxaj,15 wherein the types of cholecystobiliary fistula are reduced to two, based on whether more or less than 50% of the CBD is affected.…”

Section: Introductionmentioning

confidence: 99%

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Mirizzi syndrome: a new insight provided by a novel classification

Payá‐Llorente

Vázquez-Tarragón

Alberola-Soler

et al. 2017

Ann Hepatobiliary Pancreat Surg

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Backgrounds/Aims: Mirizzi syndrome (MS) is an uncommon complication of cholelithiasis. The aim of this study is to evaluate our 15-year experience in this challenging entity and to propose a new classification for this disease. Methods: A retrospective study including patients diagnosed with Mirizzi syndrome and undergoing surgical procedures for Mirizzi syndrome between January 2000 and October 2015 was conducted. Data collected included clinical, surgical procedure, postoperative morbidity. Patients were evaluated according to the Csendes classification and the proposed system, in which patients were divided into three types and three subtypes. Results: 28 patients were included for analysis. They accounted as the 0.5% of a total of 4853 cholecystectomies performed in the study period. There were 21 women and 7 men. Initial laparotomic approach was performed in 12 patients and in 16 patients laparoscopic procedures were attempted. The procedure was completed in only 6 patients, 5 presenting type I and 1 type II Mirizzi syndrome. Mean postoperative stay was 15±9 days. Postoperative morbidity rate was 28%. Postoperative mortality was none. Conclusions: Laparoscopic surgery for Mirizzi syndrome has been shown succesful only in early stages. A novel classification is proposed, based on the types of common bile duct injuries and in the presence cholecystoenteric fistula. (Ann Hepatobiliary Pancreat Surg 2017;21:67-75)

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Section: Discussionsupporting

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Mirizzi syndrome: a new insight provided by a novel classification

Payá‐Llorente

Vázquez-Tarragón

Alberola-Soler

et al. 2017

Ann Hepatobiliary Pancreat Surg

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“…CT may show dilation of the biliary tree and the CBD, with low sensitivity for identifying stones at these sites, but it may exclude a malignancy in the porta hepatis area or the liver. Magnetic resonance cholangiopancreatography (MRCP), is a non-invasive imaging technique with a 50% diagnostic accuracy rate, having the advantage of avoiding the complications associated with ERCP, which is considered the gold standard for diagnosing this disorder with a mean sensitivity rate of 76.2%, with technical limitations in 5% to 10% of the cases, including inaccessibility to the bile ducts and incomplete filling of the ducts because of tight strictures, additionally it is not exempt from complications such as pancreatitis, cholangitis, and residual stones (4,(14)(15)(16). Since, we lack MRCP in our institution, a preoperative diagnosis was challenging to attain, and even though almost half of our patients had a US with an impacted stone, a direct compression to the hepatic or common bile duct was difficult to visualize, therefore in patients with high suspicious of MS, a ERCP or a CT scan was ordered, visualizing a fistula in three patients with the former study, and neumobilia in four patients with the latter.…”

Section: Discussionmentioning

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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“…Recently, Béltran et al [ 6 ], reporting several cases of Mirizzi syndrome associated with cholecysto-enteric fistula, classified these cases as type V, divided into two subgroups: (a) without gallstone ileus and (b) with gallstone ileus. Later, in response to a letter by Solis-Caxaj [ 7 ], Béltran [ 8 , 9 ] simplified the classification of the syndrome identifying only three types:…”

Section: Introductionmentioning

confidence: 99%

Mirizzi Syndrome: Diagnosis and Management of a Challenging Biliary Disease

Clemente

Tringali²,

Rose

et al. 2018

Canadian Journal of Gastroenterology and Hepatology

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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.

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Mirizzi Syndrome: Diagnosis, Treatment and a Plea for a Simplified Classification

Cited by 11 publications

References 13 publications

Mirizzi syndrome: a new insight provided by a novel classification

Mirizzi syndrome: a new insight provided by a novel classification

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

Mirizzi Syndrome: Diagnosis and Management of a Challenging Biliary Disease

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