The Mirizzi syndrome

Abstract

Summary The Mirizzi syndrome is an unusual presentation of gallstones which occurs when a gallstone becomes impacted in either Hartmann's pouch of the gallbladder or the cystic duct, causing obstruction of the common hepatic duct by extrinsic compression. The diagnosis of this syndrome is of importance because surgery in its presence is associated with an increased incidence of bile duct injury. The pathology, clinical presentation and management of this syndrome are discussed, and several illustrative case reports presented.

The Mirizzi Syndrome: Multidisciplinary Management Promotes Optimal Outcomes

“…This may produce secondary stenosis of the common duct and, in the severest cases, can promote fistula formation from direct pressure necrosis of the adjacent duct walls by the impacted stone. 2 These varying degrees of pathologic involvement are well-represented in our patients.…”

“…Plain abdominal films alone have not proven useful. Similarly, US or CT scans are not often definitive although both studies may demonstrate findings that strongly suggest the diagnosis, such as: (1) dilatation of the biliary tree above the level of the gallbladder neck, (2) impaction of a stone in the gallbladder neck, and (3) a normal caliber CBD below the level of impaction. 8 Recent case reports suggest that magnetic resonance cholangiography can also be an effective method of diagnosing MS using the same criteria.…”

“…The laparoscopic approach was attempted in 14 patients but converted to an open procedure in 11 patients (78.6%) because of indistinct anatomy (6), abnormal cholangiography (3), or technical problems (2). Of the patients, 15 were noted to have extensive adhesions and severe inflammation involving the gallbladder, liver bed, portal area, cystic duct, and/or common bile duct.…”

“…1 Now known as Mirizzi syndrome (MS), this rare cause of obstructive jaundice is reported to occur in 0.7-2.5% of all U.S. patients undergoing cholecystectomy. 2,3 It is of particular importance to surgeons because the diagnosis may not be appreciated preoperatively and because the surgical treatment of this condition is associated with a significantly increased risk of bile duct injury. Furthermore, intraoperative recognition of MS may be difficult, especially if a fistula is present or extensive adhesions complicate the dissection.…”

Síndrome de Mirizzi “un caso bajo el subdiagnóstico”

“…(12) El SM se presenta en menos del 1% de los pacientes quirúrgicos, con una prevalencia del 0.05 a 0.1% en pacientes con colelitiasis y se ha descrito en 0.7 a 1.4% en pacientes con colecistectomía, según la mayoría de las publicaciones a nivel mundial. (3,7,8,(14)(15)(16)(18)(19)(20) ; pero en algunos grupos étnicos, como los nativos americanos del pueblo Navajo y Zuni se han determinado incidencias de hasta el 2,7%. (1,4,9) , al igual que en una serie mexicana estudiada por Cortez et al, donde se reportó una frecuencia del 4.7% en una población de 442 pacientes (7) .…”