The Mirizzi syndrome: multidisciplinary management promotes optimal outcomes.
ABSTRACT The Mirizzi syndrome (MS) is a rare cause of obstructive jaundice produced by the impaction of a gallstone either in the cystic duct or in the gallbladder, resulting in stenosis of the extrahepatic bile duct and, in severe cases, direct cholecystocholedochal fistula formation. Sixteen patients were treated for MS in our center over the 12-year period 1993--2005 for a prevalence of 0.35% of all cholecystectomies performed. One patient was diagnosed only at the time of cholecystectomy. The other 15 patients presented with laboratory and imaging findings consistent with choledocholithiasis and underwent preoperative endoscopic retrograde cholangiopancreatography, which established the diagnosis in all but one patient. All patients underwent cholecystectomy. An initial laparoscopic approach was attempted in 14 patients, of whom 11 were converted to open procedures. MS was recognized operatively in 15 patients with definitive stone extraction and relief of obstruction in 13 patients. T-tubes were placed in 10 patients and 1 patient required a choledochoduodenostomy. Two patients required postoperative laser lithotripsy via a T-tube tract to clear their stones; and in another patient, MS was detected and treated via postoperative endoscopic retrograde cholangiopancreatography (ERCP). MS remains a serious diagnostic and therapeutic challenge for endoscopists and biliary surgeons.
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ABSTRACT: We report a case of Mirizzi syndrome type II associated with biliary enteric fistula. It is important to identify this combination early, as it is associated with high morbidity. In our case, intraoperative findings were cholecystoduodenal fistula and communication of Hartmann's pouch with common bile duct (CBD). A subtotal cholecystectomy with excision of cholecystoduodenal fistula was performed. A minimal surgical maneuver of Calot's Triangle with repair of cholecystoduodenal fistula is required during the intraoperative period.Malaysian Journal of Medical Sciences 01/2014; 21(1):69-71.
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ABSTRACT: Although Mirizzi syndrome is widely reported in literature, little is known about acute acalcholous cholecystitis determinig the findings of a Mirizzi syndrome.BMC Surgery 11/2014; 14(1):90. · 1.24 Impact Factor
Article: Reply.World Journal of Surgery 03/2009; · 2.35 Impact Factor