| Mirizzi's syndrome | |
|---|---|
| Specialty | Gastroenterology  |
Mirizzi's syndrome is a rare complication in which a gallstone becomes impacted in thecystic duct or neck of thegallbladder 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 chroniccholecystitis (inflammation). A cholecystocholedochalfistula can occur.[1][2]
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 elevatedbilirubin andalkaline phosphatase may or may not be present. Acute presentations of the syndrome include symptoms consistent withcholecystitis.
Surgery is extremely difficult, asCalot's triangle is often obliterated, and the risks of causing injury to the CBD are high.[2]
Multiple and largegallstones can become impacted in theHartmann's pouch of thegallbladder, leading to chronicinflammation—which leads to compression of the common bile duct (CBD),necrosis, fibrosis, and ultimatelyfistula 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 obstructivejaundice. It can be divided into four types.
Type I – No fistula present
Types II–IV – Fistula present
Imaging byultrasonography,MRCP, orCT 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 onERCP when requested to alleviate obstructive jaundice or cholangitis by means of an endoscopically placed stent, or when USS has been wrongly reported as choledocolithiasis.
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]
Mirizzi's syndrome occurs in approximately 0.1% of patients withgallstones.[5] It is found in 0.7 to 2.5 percent ofcholecystectomies.[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.
It is named for Argentinian physician Pablo Luis Mirizzi[2] (1893–1964). Mirizzi was educated and trained in his hometown and later visited some of the best hospitals throughout the US for further education and training. Mirizzi specialized in abdominal and thoracic surgery and would write prolifically on related surgical topics.[6][7] In 1931, he performed the first intraoperative cholangiogram.[8] Mirizzi suggested the name of the phenomenon would be "hepatic duct syndrome."[2]
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