Preoperative diagnosis of the Mirizzi syndrome: limitations of sonography and computed tomography

Becker, Christoph; Hassler, H; Terrier, F

doi:10.2214/ajr.143.3.591

Cited by 95 publications

(52 citation statements)

References 6 publications

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“…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 . Tomografia computadorizada (TC) pode ser utilizada, entretanto, os sinais radiológicos não são específicos 17 .…”

Section: Discussionunclassified

Manejo cirúrgico da síndrome de Mirizzi

Fonseca-Neto¹,

Pedrosa²,

Miranda³

2008

ABCD, arq. bras. cir. dig.

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A associação entre fístula coledocociana e coledocolitíase foi observada em três pacientes (60%). Quanto à classificação, encontrou-se dois pacientes com tipo I e um paciente em cada um dos tipos II, III, IV. A colecistectomia foi realizada em todos os pacientes, sendo parcial em três (60%). A anastomose coledocoduodenal foi realizada em dois pacientes, sendo do tipo látero-lateral. A coledojejunoanastomose ocorreu em um único caso (tipo IV). Evolução pós-operatória sem alterações ocorreu em dois casos (40%) recebendo alta em boas condições. Um paciente apresentou sepse no pós-operatório secundário a abscesso subhepático evoluindo ao óbito no 2° dia de pós-relaparotomia. Conclusão -Apesar do diagnóstico pré-operatório ser raro nos pacientes com síndrome de Mirizzi, ela deve ser suspeitada na colelitíase crônica e prontamente identificada no intra-operatório para evitar lesões biliares inadvertidas. Apesar da era da colecistectomia laparoscópica, o método aberto deve ser o de escolha. DESCRITORES -Injúria do ducto biliar. Bypass biliar. Mirizzi. Colecistectomia. Cirurgia biliar. ABCD Arq Bras Cir DigArtigo Original 2008;21(2):51-4 MAnEJO CIRÚRGICO DA SÍnDROME DE MIRIZZI Surgical management of Mirizzi syndromeOlival Cirilo Lucena da fONSECA-NETO, Maria das Graças Lapenda PEDROSA, Antonio Lopes MIRAnDA InTRODUçãO A síndrome de Mirizzi é a obstrução do ducto hepático comum secundária a compressão extrínseca devido a impactação de cálculos no ducto cístico ou no infundíbulo da vesícula1. É complicação não-usual da doença litíasica da vesícula biliar e ocorre em aproximadamente 1% de todos os pacientes com colelitíase 20 .A importância dela deriva do alto risco de lesões do ducto biliar durante os procedimentos cirúrgicos. Soma-se a esse fato a dificuldade do diagnóstico antes da operação. Em pacientes ictéricos ou não, operações de emergência e escassos recursos radiológicos proporcionam condição propícia para lesões iatrogênicas da via biliar.O objetivo deste estudo é descrever uma série de cinco pacientes com síndrome de Mirizzi, submetidos a tratamento cirúrgico, e comentar os aspectos etiopatogêni-cos e apresentação clínica, enfatizando o diagnóstico e o tratamento dessa complicação da litíase biliar.

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Section: Discussionunclassified

Manejo cirúrgico da síndrome de Mirizzi

Fonseca-Neto¹,

Pedrosa²,

Miranda³

2008

ABCD, arq. bras. cir. dig.

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“…Common practice is to begin with gallbladder cuff may be indicated. Intraoperative cholangiography should be performed to assist in the identiultrasound or CT and then advance to cholangiography if indicated [6,14]. Typical ultrasound findings include fication of fistulae and anomalous anatomical structures as indicated in patient 3.…”

Section: Discussionmentioning

confidence: 99%

“…obstruction [4,5]. A critical aspect of this rare condition is its similarity to biliary malignancy on cholangiography Patient 2 [6], and the recently reported association with gallbladder A 42-year-old woman was referred after a 4-week history of progressive jaundice, pruritus, and epigastric discomfort. She reported a carcinoma [4].…”

Section: Introductionmentioning

confidence: 99%

Mirizzi Syndrome: A Rare Cause of Obstructive Jaundice

Freeman¹,

Rose²,

Forsmark

et al. 1999

Dig Dis

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Mirizzi syndrome is a rare cause of bile duct obstruction secondary to extrinsic compression of the hepatic duct by stones impacted in the cystic duct or infundibulum of the gallbladder. The suspicion of Mirizzi syndrome primarily relies on radiographic means such as ultrasound, computed tomography and cholangiography. The recognition of this rare syndrome is crucial in developing the proper treatment approach. We present 3 cases of Mirizzi syndrome and a review of the literature pertaining to the diagnosis and treatment of this rare cause of obstructive jaundice.

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“…Ultrasound has. however, been shown to be the best screening method [13,14]. Preoperative confir mation of the diagnosis can be achieved by ERCP and/or percutaneous transhepatic cholangiography [14,15].…”

Section: Discussionmentioning

confidence: 99%

A Standardized Surgical Approach for the Treatment of Mirizzi Syndrome

Krähenbühl¹,

Moser²,

Redaelli³

et al. 1997

Dig Surg

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Mirizzi syndrome is a rare complication of long-standing gallstone disease and is defined as a partial or complete common bile duct obstruction caused by an impacted gallstone in the gallbladder neck or cystic duct. A subclassification of Mirizzi syndrome into type-I and II lesions has been proposed. Based on this classification a standardized surgical approach is now proposed. In a retrospective series of 18 cases with Mirizzi syndrome, found among 1,759 cholecystectomies performed since June 1986, we treated 7 type-I and 11 type-II lesions. There were 11 females and 7 males with an average age of 74.8 (range 32-87) years, and there was an increased incidence (27%) of concomitant gallbladder cancer found. All type-I lesions were treated by partial cholecystectomy, and 5 patients had concomitant exploration of the common bile duct with T-tube drainage. All type-II lesions received cholecystocholedochalenteric bypass surgery, namely 8 with a Roux-en-Y enterostomy and 3 with duodenostomy. Two patients (1 type-I+ and 1 type-II lesion) had a laparoscopic approach but needed conversion to open surgery because of severe inflammatory adhesions. There was no postoperative mortality and postoperative morbidity was low at 27% (5 of 18 patients). We had 1 case with postoperative bile leakage and 1 with hemorrhage. Three patients who had had biliary-enteric bypass procedures developed benign hepatic duct strictures which were all treated conservatively using endoscopic stenting. This management strategy has yielded very satisfactory results and laparoscopic surgery has been limited to a very small number of patients with type-I lesions.

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Preoperative diagnosis of the Mirizzi syndrome: limitations of sonography and computed tomography

Cited by 95 publications

References 6 publications

Manejo cirúrgico da síndrome de Mirizzi

Manejo cirúrgico da síndrome de Mirizzi

Mirizzi Syndrome: A Rare Cause of Obstructive Jaundice

A Standardized Surgical Approach for the Treatment of Mirizzi Syndrome

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