Cholecysto-choledochal fistula--Mirizzi syndrome (type II) in a Nigerian.

Department of Surgery, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.
The Central African journal of medicine 07/1993; 39(6):126-8.
Source: PubMed


Mirizzi syndrome is an uncommon cause of obstructive jaundice in which the common hepatic duct is obstructed by stones trapped within the neck of the cystic duct of the gall-bladder. In long standing cases the calculi may erode through into the common duct and may in fact, impact in the resulting fistula. This syndrome with its later progression is a rare complication of calculous disease of the gall-bladder worldwide. While it is perhaps encountered in the developing countries where cholelithiasis is not as prevalent as in the affluent countries, there has not been much documentation. This article reports on a Nigerian patient with a fistulous complication of Mirizzi syndrome (Type II) managed by cholecystectomy and choledochoduodenostomy and also presents a discussion of the condition.

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    ABSTRACT: Thirty-one patients with biliary enteric fistula who were operated on over a 19-year period (1976-1994) with an incidence of 0.74% in all biliary tract operations were reviewed retrospectively to identify etiologic factors, types of fistulas, signs and symptoms, methods of diagnosis, management and prognosis of the cases. Most common symptoms were abdominal pain, nausea, vomiting and jaundice. Two patients had gallstone ileus. The majority of the patients had severe concomitant medical illnesses. The exact preoperative diagnosis of a biliary enteric fistula was established in only five (16%) patients. In 81% of the cases fistula was secondary to chronic calculous biliary tract disease. Postoperative complications included wound infection in six (19%), biliary fistula in two (6%) and erosive gastritis in one (3%) patient. Two patients died of intra-abdominal sepsis and two of cardiac failure, with an operative mortality of 13%. Early elective cholecystectomy is recommended to avoid complications of chronic calculous cholecystitis such as bilioenteric fistulas and their increased mortality and morbidity.
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