Radiology of the Mirizzi syndrome: Diagnostic importance of the transhepatic cholangiogram

Abstract

The essential feature of the MIrizzi syndrome is partial common hepatic duct obstruction due to an impacted cystic duct stone. This entity has rarely been reported but is apparently more common than previously thought. Our review of the world literature shows 42 proven cases in 18 publications from 7 different countries. We are adding 11 further cases with surgical proof. The preoperative x-ray diagnosis of the Mirizzi syndrome was established in 10 of the 42 previously reported cases. This diagnostic problem was probably due to limitations of plain film and intravenous cholangiography techniques. The preoperative diagnosis was possible in 8 of our 11 cases, primarily with the use of transhepatic cholangiography. The preoperative diagnosis is important and can lead to a decrease in surgical complications, particularly if stone penetration, fistula formation, and adjacent inflammatory masses are demonstrated.

Appraisal of diagnosis and surgical approach for Mirizzi syndrome

“…ERCP is the current gold standard for the diagnosis of Mirizzi syndrome. It also delineates the cause, level and extent of biliary obstruction, as well as ductal abnormalities, including fistula . We found there were more patients that needed ERCP and CT examination in patients with cholecystobiliary fistula than without cholecystobiliary fistula.…”

Mirizzi syndrome: a new insight provided by a novel classification

“…ERCP is considered the gold standard for the diagnosis of Mirizzi syndrome,2526 with its sensitivity ranging from 55% to 90% 27. In addition to being a diagnostic procedure, it is also a therapeutic technique that enables extraction of gallstones from the CBD or biliary drainage using stents, allowing for elective surgery to be performed 28.…”

Mirizzi syndrome: An extra hazard for laparoscopic surgery

“…Curet recommended the use of ERCP in the preoperative assessment of a patient with cholecystitis and jaundice 3 . Intravenous or percutaneous cholangiography have, in the past, been advocated, but are no longer appropriate 20,21 . The roles of helical CT with intravenous contrast and magnetic resonance cholangiography remain to be evaluated.…”