The typical diagnostic signs of the mirizzi syndrome are 1 dilatation of the common hepatic duct above the level of 2 a gallstone impacted in. As presented, this interesting patient fulfills the basic criteria for mirizzis syndrome, an unusual complication of gallstone disease that occurs in only 0. Hiwa omer ahmed assistant professor in surgery mirizzi syndrome the stone ulcerating through into the cbd mirizzis syndrome is a condition characterized by stricture of the common hepatic duct. Laparoscopic subtotal cholecystectomy is useful for patients with mirizzi syndrome. Mirizzis syndrome is a health condition that involves an obstruction of the common hepatic duct or the common bile duct, as an end result of an extrinsic compression by an impacted stone which is located in the cystic duct, or in the hartmanns pouch found in the gallbladder.
Mirizzi syndrome with an unusual type of biliobiliary fistula. Laparoscopic subtotal cholecystectomy for mirizzi syndrome. An impacted stone in the gallbladder infundibulum or cystic duct can compress the bile duct, usually at the level of the common hepatic duct type i, or a stone can. Mirizzi syndrome is a condition difficult to diagnose and treat, representing a particular challenge for the biliary surgeon. Mirizzi s syndrome is a rare complication in which a gallstone becomes impacted in the cystic duct or neck of the gallbladder causing compression of the common hepatic duct, resulting in obstruction and jaundice. In type ii lesions a cholecystobiliary fistula is present with erosion of less than one. The current concept of mirizzi syndrome, includes the external compression of the bile duct and the later development of cholecystobiliary and cholecystoenteric fistulas as different stages of the same disease process4,7,8. Mirizzi syndrome is an unusual presentation of obstructive jaundice caused by extrinsic compression of an extrahepatic biliary duct from one or more calculi within the cystic duct or gallbladder. Mirizzi and presents unusual lodged gallstone in either the cystic duct or most frequently in hartmann pouch of the gallbladder. We herein reported a case of mirizzi syndrome ms with an unusual type of bbf corlette type i that was successfully managed by a staged treatment strategy.
Mirizzi syndrome ms is an unusual complication of gallstone disease. The complete and definitive treatment of patients with mirizzi syndrome is surgical. In order to draw attention to this rare occurrence, we preferred a 14yearold male patient with mirizzi syndrome. The disease can mimic cancer of the gallbladder, causing considerable diagnostic difficulties. The diagnosis of this syndrome is of importance because surgery in its presence is associated with an increased incidence of bile duct injury. The mirizzi syndrome is an unusual presentation of gallstones which occurs when a. Incidence and management of mirizzi syndrome during. Mirizzi syndrome is a rare complication of longstanding. Mirizzis syndrome was an obstruction caused by gallstone located in gallbladder neck or cystic duct or.
Furthermore, it increases the risk of intraoperative biliary injury during cholecystectomy. Mcsherry, ck, furstenberg, h, virshup, m 1982 the mirizzi syndrome. Mirizzi syndrome is a complication of long standing cholelithiasis. Mirizzi syndrome and gallbladder cancer springerlink. Ercp reports of patients presenting for endoscopic management of choledocholithiasis between march 1989 and june 1995. Mirizzi described an unusual presentation of gallstones which, when lodged in either the cystic duct or the hartmann pouch of the gallbladder, externally compressed the common hepatic duct chd, causing symptoms of obstructive. Mirizzi syndrome is a rare and challenging clinical entity to manage.
Mirizzi syndrome digestive system health sciences free. The obstructive jaundice can be caused by direct extrinsic compression by the stone or from fibrosis caused by chronic cholecystitis inflammation. Preoperative recognition of the mirizzi syndrome permits avoidance of several serious pitfalls at surgery. The typical diagnostic signs of the mirizzi syndrome are 1 dilatation of the common hepatic duct above the level of 2 a gallstone impacted in the cystic duct, with 3 normal duct width below the stone. Mirizzi syndrome tends to affect older patients it is named after pablo mirizzi, an argentinean physician. Mirizzis syndrome treatment, classification, symptoms, types. Mirizzi syndrome is a rare complication of gallstone disease, with a reported incidence between 0. It is a functional hepatic syndrome but can often present with biliary duct dilatation and can mimic other hepatobiliary pathologies such as cholangiocarcinoma 2. It was named after pablo mirizzi, who defined the syndrome as a benign common hepatic duct obstruction due to gallstone impaction in the gallbladder neck resulting in local inflammation and bile duct spasm. The surgical treatment of mirizzi syndrome requires. We report our experience of gallbladder carcinoma in patients with mirizzi syndrome. Mirizzi syndrome ms is a rare complication of cholelithiasis. Sep 14, 2012 mirizzi syndrome type vb is a matter of controversy, nonetheless, it seems advisable to treat the acute condition first gallstone ileus and at a second time after the patient has recovered from surgery 3 or more months later, approach the gallbladder according to the presence or absence of external compression of the bile duct or. Mirizzi syndrome, known as extrinsic bile compression syndrome, is a rare complication of cholecystitis and chronic cholelithiasis, secondary to the o.
Laparoscopic subtotal cholecystectomy was successfully performed for a patient. Genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 tollfree. Mirizzis syndrome is a rare condition complicating gall stone disease. Mirizzi syndrome, known as extrinsic bile compression syndrome, is a rare complication of cholecystitis and chronic cholelithiasis, secondary to the obliteration of the infundibulum of the gallbladder or cystic duct caused by the impact of one or more calculations in these anatomical structures, which leads to compression of the adjacent bile duct, resulting in partial or complete obstruction. This case illustrates an absolutely asymptomatic presentation of mirizzi syndrome in a 62yearold, otherwise healthy, woman. Mirizzis syndrome an overview sciencedirect topics.
When a gallstone blocks the common hepatic duct, thereby preventing bile from draining out of the liver, jaundice may develop. As presented, this interesting patient fulfills the basic criteria for mirizzi s syndrome, an unusual complication of gallstone disease that occurs in only 0. Altered biliary tract anatomy and the associated pathology make cholecystectomy, open or laparoscopic, a formidable undertaking. The accepted management of mirizzis syndrome is surgical, but endoscopic and percutaneous management have been described. Mirizzi s syndrome is a rare and chronic inflammation caused by a gallstone impacted in the hartmanns pouch with partial or complete obstruction of the main bile duct, which results in difficult. Despite the success of laparoscopic cholecystectomy as a minimally invasive approach to gallstone disease, ms remains a challenge, also for open and robotic approaches, due to the subverted anatomy of the hepatocystic triangle.
According to mirizzi s classification and csendess subclassification, mirizzi syndrome type iv. An uncommon complication of cholelithiasis, mirizzis syndrome should be included in the differential diagnosis of any patient who has extrahepatic biliary obstruction. Appraisal of diagnosis and surgical approach for mirizzi syndrome. The rates of bile duct injuries is high after laparoscopic cholecystectomy. Management of mirizzi syndrome in emergency journal of. Laparoscopic surgery in the treatment of mirizzi syndrome. The condition is often confused with other serious conditions such as hilar cholangiocarcinoma, which present with similar. Pubmed is a searchable database of medical literature and lists journal articles that discuss mirizzi syndrome. It is a functional hepatic syndrome but can often present with biliary duct dilatation and can mimic other hepatobiliary pathologies such as. Accompanying features can be fever and right upper quadrant pain. Mirizzis syndrome may be mistaken for pancreatic cancer or cholangiocarcinoma p. Prevalence mirizzi syndrome is estimated to occur in 0. A stone in the gall bladder sometimes can compress the common bile duct and cause jaundice. Mirizzi syndrome with an unusual type of biliobiliary.
Mirizzis syndrome is a rare complication in which a gallstone becomes impacted in the cystic duct or neck of the gallbladder causing compression of the cbd common bile duct, resulting in cbd obstruction and jaundice. Mirizzis syndrome treatment in india diagnosis of mirizzi. If you have problems viewing pdf files, download the latest version of adobe reader. This occurrence is rare and, in english literature, three cases defined in children have been observed. Subtotal cholecystectomy, in which a minimal portion of the neck side of the gallbladder is left in place, is considered to be the best treatment for. Removal of the stone is the main purpose of treatment. Since laparoscopic bile duct exploration and repair have not been adopted by most laparoscopic surgeons as a stand ard treatment option, conversion to open. Mirizzis syndrome masquerading as cholangiocarcinoma. Mirizzi syndrome refers to an uncommon phenomenon that results in extrinsic compression of an extrahepatic biliary duct from one or more calculi within the cystic duct or gallbladder. Mirizzi syndrome can be caused by an acute or chronic inflammatory condition secondary to a single large gallstone or multiple small. Oct 17, 2018 mirizzi syndrome is an unusual presentation of obstructive jaundice caused by extrinsic compression of an extrahepatic biliary duct from one or more calculi within the cystic duct or gallbladder.
The incidence of mirizzi syndrome among patients with gallstones is reported to range from 0. Click on the link to view a sample search on this topic. Mirizzi syndrome is a condition characterized by extrinsic biliary compression by gallstones. Mirizzis syndrome the indonesian journal of gastroenterology.
The mirizzi syndrome is an unusual presentation of gallstones which occurs when a gallstone becomes impacted in either hartmanns pouch of the gallbladder or the cystic duct, causing obstruction of the common hepatic duct by extrinsic compression. Mirizzi syndrome is the compressive blockage of the cystic or choledochal duct caused by a biliary stone occupying the cystic canal or hartmanns pouch. May 27, 2007 mirizzi syndrome is a rare complication of prolonged cholelithiasis with presence of large, impacted gallstone into the hartmans pouch, causing chronic extrinsic compression of common bile duct cbd. However, recent advances in technology have provided surgeons with new options for more effective diagnosis and treatment of this condition. Mirizzi syndrome history, present and linkedin slideshare. Current trends in the management of mirizzi syndrome. Mirizzi syndrome refers to compression of the common. Mirizzi syndrome, known as extrinsic bile compression syndrome, is a rare complication of cholecystitis and chronic cholelithiasis, secondary to the obliteration of the infundibulum of the gallbladder or cystic duct caused by the impact of one or more calculations in these anatomical structures, which leads to compression of the adjacent bile duct, resulting in partial or complete.
The purpose of this study is to retrospectively estimate the diagnostic and treatment methods applied in patients with mirizzi syndrome. Mirizzi syndrome genetic and rare diseases information. May 21, 2008 mirizzi syndrome is an unusual complication of gallstone disease and occurs in approximately 1% of all patients with cholelithiasis. Occasionally it may erode into the bile duct and cause a fistula between the gall bladder and the bile duct. Appraisal of diagnosis and surgical approach for mirizzi. Mirizzi syndrome description, causes and risk factors.
Lai and wan yee lau department of surgery, prince of wales hospital, the chinese university of hong kong, shatin, new territories, hong kong background. The syndrome was first described in 1948 and is characterized by impaction of stones in the cystic duct or neck of the gallbladder, resulting in mechanical obstruction of the common hepatic duct and frequent clinical presentation of intermittent or constant. Mirizzis syndrome is a rare complication in which a gallstone becomes impacted in the cystic duct or neck of the gallbladder causing compression of the common hepatic duct, resulting in obstruction and jaundice. Occasionally it may erode into the bile duct and cause a fistula between the gall bladder and the bi. In choledochoplasty, we the utilize a pedicled graft of gallbladder remnant in treatment of mirizzis syndrome 8, 9. The condition is caused by a stone impacted in the gall bladder neck or cystic duct that impinges on the common hepatic duct, with or without a cholecystocholedochal fistula. At present, a standard treatment of mirizzi syndrome is not yet well defined, due to the heterogeneous clinical presentation. They were diagnosed either by imaging techniques, or during surgical operation.
Our experience with 27 cases with mirizzi syndrome is presented. Mirizzi syndrome is defined as biliary obstruction secondary to cholecystitis. Mirizzi syndrome is a rare complication of gallstone disease gsd. For language access assistance, contact the ncats public information officer.
Minimally invasive treatment of mirizzi syndrome, a rare. Mirizzi syndrome is a rare complication of cholelithiasis reported to occur in 1% of all patients with gall stones and an incidence of 0. Mirizzi syndrome is a rare complication of gallstone disease. A new classification of patients with mirizzi syndrome and cholecystobiliary fistula is presented. Pablo mirizzi in 1948 highlighted this condition where the common hepatic duct chd obstruction was caused by impacted gallbladder or cystic duct stones, or adjacent inflammation. Type i lesions are those with external compression of the common bile duct. The association of mirizzi syndrome and gallbladder carcinoma gbc is not well understood. Mirizzi syndrome medigoo health medical tests and free. The obstructive jaundice can be caused by direct extrinsic compression by the stone. Mirizzis syndrome is a rare and chronic inflammation caused by a gallstone impacted in the hartmanns pouch with partial or complete obstruction of the main bile duct, which results in difficult. According to mirizzis classification and csendess subclassification, mirizzi syndrome type.
Mirizzi syndrome is a rare complication of prolonged cholelithiasis with presence of large, impacted gallstone into the hartmans pouch, causing chronic extrinsic compression of common bile duct cbd. The incidence of mirizzi syndrome was determined as 0. In this, obstruction of the extrahepatic bile duct by stones in the hartmans pouch or cystic duct mirrizi type i may erode in to the bile duct forming cholecystobiliary fistula mirrizi type ii. It is a functional hepatic syndrome but can often present with biliary duct dilatation and can mimic other hepatobiliary pathology such as cholangiocarcinoma. Fistula formation between the cbd and the gallbladder may represent an outcome of that condition. This study aims to evaluate the treatment approach by analysing the diagnostic method and the outcome of surgical treatment in our hospital. A surgery was performed and the final pathologic diagnosis is a complication of xanthogranulomatous cholecystitis with mirizzi syndrome. Nov 27, 2014 mirizzi syndrome history, present and 1. Mirizzi syndrome is often difficult to diagnose before surgery, and is often accompanied by extensive adhesions in the cystohepatic calots triangle and the. Mirizzi syndrome is a rarely observed complication of gallstone disease, causing major biliary problems, if not diagnosed previously. Pdf mirizzi syndrome is a rare cause of obstructive jaundice. Introduction refers to common hepatic duct obstruction caused by an extrinsic compression from an impacted stone in the cystic duct or hartmanns pouch of the gallbladder occurs in approximately 0. Discussion mirizzi syndrome is a rare complication of gallstones and occurs in approximately 0. A complication of xanthogranulomatous cholecystitis with.
We retrospectively analysed the data of 198 patients with mirizzi syndrome between january 2004 and january 2010. Pablo mirizzi in 1948 highlighted this condition where the common hepatic duct chd obstruction was caused by impacted gallbladder or cystic duct stones, or adjacent inflammation 1. Mirizzi syndrome, also known as extrinsic biliary compression syndrome, is a rare clinical entity in which the common bile duct is obstructed by compression by the impaction of one or more gallstones in the cystic duct or gallbladder infundibulum. Mirizzi syndrome is an important and rare complication of gallstone disease. The accepted management of mirizzi s syndrome is surgical, but endoscopic and percutaneous management have been described. Mirizzi syndrome is a rare complication of long standing cholelithiasis. Aug 20, 2012 mirizzi syndrome is an important and rare complication of gallstone disease. The patient was diagnosed with a solitary gallstone, marked atrophy of the. The study included male and 21 female patients, with a mean age of 67. Approximately 50 to 77 percent of patients with mirizzi syndrome are women, which may in part be due to a higher incidence of gallstones in women. Mirizzis syndrome is a rarely observed disorder that presents with obstructive jaundice. Pdf file of the complete article 997k, or click on a page image below to browse page by page. In type ia, fundusfirst cholecystectomy with simple closure of cystic duct while in type ib choledochoplasty.
Jun 17, 2015 gallstone obstruction of the cystic duct, resulting in chronic cholecystitis and pressure necrosis leads to the formation of biliobiliary fistula bbf. Gallstone obstruction of the cystic duct, resulting in chronic cholecystitis and pressure necrosis leads to the formation of biliobiliary fistula bbf. We present a case of a patient who underwent open rather than coelioscopic cholecystectomy based upon the preoperative diagnosis of mirizzis syndrome. Search icd10 code lookup find diagnosis codes icd10cm and procedure codes icd10pcs by disease, condition or icd10 code. Mirizzi syndrome refers to compression of cbd or chd from one or more calculi at the cystic duct or neck of gall bladder resulting in obstruction and jaundice.
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