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. The obstructive jaundice can be caused by direct extrinsic compression by the stone or from fibrosis caused by chronic cholecystitis (inflammation). A cholecystocholedochal fistula can occur.[1]
Mirizzi's syndrome has no consistent or unique clinical features that distinguish it from other more common forms of obstructive jaundice. Symptoms of recurrent cholangitis, jaundice, right upper quadrant pain, and elevated bilirubin and alkaline phosphatase may or may not be present. Acute presentations of the syndrome include symptoms consistent with cholecystitis.
Surgery is extremely difficult as Calot's triangle is often obliterated and the risks of causing injury to the CBD are high.[2]
Pathophysiologyedit
Multiple and large gallstones can become impacted in the Hartmann's pouch of the gallbladder, leading to chronic inflammation—which leads to compression of the common bile duct (CBD), necrosis, fibrosis, and ultimately fistula formation into the adjacent common hepatic duct (CHD) or common bile duct (CBD). As a result, the CHD/CBD becomes obstructed by either scar or stone, resulting in obstructive jaundice. It can be divided into four types.
Type I – No fistula present
Type IA – Presence of the cystic duct
Type IB – Obliteration of the cystic duct
Types II–IV – Fistula present
Type II – Defect smaller than 33% of the CHD diameter
Type III – Defect 33–66% of the CHD diameter
Type IV – Defect larger than 66% of the CHD diameter
Diagnosisedit
Imaging by ultrasonography, MRCP, or CT scan usually make the diagnosis.[3]MRCP can be used to define the lesion anatomically prior to surgery.[citation needed] Occasionally Mirizzi's syndrome is diagnosed or confirmed on ERCP when requested to alleviate obstructive jaundice or cholangitis by means of an endoscopically placed stent, or when USS has been wrongly reported as choledocolithiasis.
Treatmentedit
Simple cholecystectomy is suitable for type I patients. For types II–IV, subtotal cholecystectomy can be performed to avoid damage to the main bile ducts. Cholecystectomy and bilioenteric anastomosis may be required. Roux-en-Y hepaticojejunostomy has shown good outcome in some studies.[4]
Epidemiologyedit
Mirizzi's syndrome occurs in approximately 0.1% of patients with gallstones.[5] It is found in 0.7 to 2.5 percent of cholecystectomies.[1]
It affects males and females equally, but tends to affect older people more often. There is no evidence of race having any bearing on the epidemiology.
Eponymedit
It is named for Pablo Luis Mirizzi (1893–1964), an Argentinian physician. Mirizzi was educated and trained in his hometown and later visited some of the best hospitals throughout the United States for further education and training. Mirizzi specialized in abdominal and thoracic surgery and would write prolifically on related surgical topics.[6][7]
Referencesedit
^ abVitale M. Mirizzi Syndrome Type IV: An Atypical Presentation That Is Difficult to Diagnose Preoperatively. 2009. Society for Surgery of the Alimentary Tract.http://www.ssat.com/cgi-bin/abstracts/09ddw/P7.cgi
^Ross, Jeffrey W; Gary S Sudakoff; Gregory B Snyder (2006-12-29). Neela Lamki; Bernard D Coombs; Abraham H Dachman; Robert M Krasny; John Karani (eds.). "Mirizzi syndrome". eMedicine. WebMD. Retrieved 2007-12-09.
^Aydin, U., P. Yazici, et al. (2008). "Surgical management of Mirizzi syndrome." Turk J Gastroenterol 19(4): 258–263. . Archived from the original on 2014-07-15. Retrieved 2013-06-19.
^Hazzan, D; D Golijanin; P Reissman; SN Adler; E Shiloni (June 1999). "Combined endoscopic and surgical management of Mirizzi syndrome". Surgical Endoscopy. 13 (6): 618–20. doi:10.1007/s004649901054. PMID 10347304.
^Mirizzi PL: Syndrome del conducto hepatico. J Int de Chir 1948; 8: 731–77
External linksedit
April 13, 2024
mirizzi, syndrome, rare, complication, which, gallstone, becomes, impacted, cystic, duct, neck, gallbladder, causing, compression, common, hepatic, duct, resulting, obstruction, jaundice, obstructive, jaundice, caused, direct, extrinsic, compression, stone, fr. 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 The obstructive jaundice can be caused by direct extrinsic compression by the stone or from fibrosis caused by chronic cholecystitis inflammation A cholecystocholedochal fistula can occur 1 Mirizzi s syndromeSpecialtyGastroenterology Impacted gallstone in the cystic duct is obstructing the common hepatic duct Contents 1 Presentation 2 Pathophysiology 3 Diagnosis 4 Treatment 5 Epidemiology 6 Eponym 7 References 8 External linksPresentation editMirizzi s syndrome has no consistent or unique clinical features that distinguish it from other more common forms of obstructive jaundice Symptoms of recurrent cholangitis jaundice right upper quadrant pain and elevated bilirubin and alkaline phosphatase may or may not be present Acute presentations of the syndrome include symptoms consistent with cholecystitis Surgery is extremely difficult as Calot s triangle is often obliterated and the risks of causing injury to the CBD are high 2 Pathophysiology editMultiple and large gallstones can become impacted in the Hartmann s pouch of the gallbladder leading to chronic inflammation which leads to compression of the common bile duct CBD necrosis fibrosis and ultimately fistula formation into the adjacent common hepatic duct CHD or common bile duct CBD As a result the CHD CBD becomes obstructed by either scar or stone resulting in obstructive jaundice It can be divided into four types Type I No fistula present Type IA Presence of the cystic duct Type IB Obliteration of the cystic ductTypes II IV Fistula present Type II Defect smaller than 33 of the CHD diameter Type III Defect 33 66 of the CHD diameter Type IV Defect larger than 66 of the CHD diameterDiagnosis editImaging by ultrasonography MRCP or CT scan usually make the diagnosis 3 MRCP can be used to define the lesion anatomically prior to surgery citation needed Occasionally Mirizzi s syndrome is diagnosed or confirmed on ERCP when requested to alleviate obstructive jaundice or cholangitis by means of an endoscopically placed stent or when USS has been wrongly reported as choledocolithiasis Treatment editSimple cholecystectomy is suitable for type I patients For types II IV subtotal cholecystectomy can be performed to avoid damage to the main bile ducts Cholecystectomy and bilioenteric anastomosis may be required Roux en Y hepaticojejunostomy has shown good outcome in some studies 4 Epidemiology editMirizzi s syndrome occurs in approximately 0 1 of patients with gallstones 5 It is found in 0 7 to 2 5 percent of cholecystectomies 1 It affects males and females equally but tends to affect older people more often There is no evidence of race having any bearing on the epidemiology Eponym editIt is named for Pablo Luis Mirizzi 1893 1964 an Argentinian physician Mirizzi was educated and trained in his hometown and later visited some of the best hospitals throughout the United States for further education and training Mirizzi specialized in abdominal and thoracic surgery and would write prolifically on related surgical topics 6 7 References edit a b Vitale M Mirizzi Syndrome Type IV An Atypical Presentation That Is Difficult to Diagnose Preoperatively 2009 Society for Surgery of the Alimentary Tract http www ssat com cgi bin abstracts 09ddw P7 cgi eMRCS www emrcs com Retrieved 2015 09 04 Ross Jeffrey W Gary S Sudakoff Gregory B Snyder 2006 12 29 Neela Lamki Bernard D Coombs Abraham H Dachman Robert M Krasny John Karani eds Mirizzi syndrome eMedicine WebMD Retrieved 2007 12 09 Aydin U P Yazici et al 2008 Surgical management of Mirizzi syndrome Turk J Gastroenterol 19 4 258 263 Blog sante bien etre medicaments et traitements de monsieur Turk Archived from the original on 2014 07 15 Retrieved 2013 06 19 Hazzan D D Golijanin P Reissman SN Adler E Shiloni June 1999 Combined endoscopic and surgical management of Mirizzi syndrome Surgical Endoscopy 13 6 618 20 doi 10 1007 s004649901054 PMID 10347304 synd 3587 at Who Named It Mirizzi PL Syndrome del conducto hepatico J Int de Chir 1948 8 731 77External links edit Retrieved from https en wikipedia org w index php title Mirizzi 27s syndrome amp oldid 1187675961, wikipedia, wiki, book, books, library,
