Sep 14, 2012 the incidence of the different types of mirizzi syndrome according to beltran and csendes is detailed in table table3. The disease can mimic cancer of the gallbladder, causing considerable diagnostic difficulties. We assessed current age, gender, time of disease, diagno sis, treatment performed and postoperative outcome. Operative treatment of mirizzi syndrome type ii includes laparoscopic or open subtotal cholecystectomy.
Bile duct reconstruction becomes more difficult with increases in the size of the cholecystocholedochal fistula. 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. Mirizzi v, however, could be present in up to 29% patients with any other type of mirizzi. The main role of ct is to differentiate mirizzi syndrome from a malignancy in the area of porta hepatis or in the liver. 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. 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. Current trends in the management of mirizzi syndrome.
Mirizzi syndrome type iii consists of a cholecystobiliary fistula involving up to twothirds of the bile duct circumference. Ercp with computed tomographic ct scan or intraoperative exploration and assessment with ultrasonography establishes mirizzi types 1 or 2, the current robotic surgical system offers an effective treatment of the syndrome. This entity should be considered in the d i ff e rential diagnosis of all patients with obstru c t i v e jaundice. Mirizzi syndrome type iv associated with cholecystocolic. Mirizzi syndrome is a condition difficult to diagnose and treat, representing a particular challenge for the biliary surgeon. Its more frequent on women between 21 to 90 years old, probably a reflection of the gallstones preponderance in this group. Mirizzi syndrome or extrinsic biliary compression syndrome, is a rare complication of cholelithiasis. Minimally invasive treatment of mirizzi syndrome, a rare. The latest version of icd10 is updated each year on october 1. This technique was applied via the endoscopic retrograde route. A collection of disease information resources and questions answered by our genetic and rare diseases information specialists for mirizzi syndrome. Mirizzis syndrome treatment, classification, symptoms, types. According to pathophysiological features, mirizzi syndrome can be classified into several different types table table1.
However, in developing countries, especially in latin america, mirizzi syndrome remains a common occurrence, with an incidence ranging from 4. Mirizzi syndrome is a rare complication and it occurs approximately on 0. Mirizzis syndrome may be mistaken for pancreatic cancer or cholangiocarcinoma p. The goal of this report is to present a case of a patient carrying type iv, surgically treated through the laparotomy approach. Jan 26, 2018 according to pathophysiological features, mirizzi syndrome can be classified into several different types table table1.
With the ultra high magnification of the surgical field. Role of robotic surgery in the treatment of mirizzi syndrome. This case illustrates an absolutely asymptomatic presentation of mirizzi syndrome in a 62yearold, otherwise healthy, woman. Other types of mirizzi yndrome are relatively low in incidence. Feb 14, 2019 mirizzi syndrome is defined as common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder. Aug 20, 2012 the incidence of types i, ii, iii and iv was 59. Appraisal of diagnosis and surgical approach for mirizzi syndrome. It is important to properly identify the anatomy at the time of surgery to avoid compromising the common bile duct. About 1 items found relating to mirizzi s syndrome. 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 syndrome1,2 is a rare complication of cholelithiasis, caused by an extrinsic compression of the common hepatic duct from a stone in the gallbladder neck or in the cystic duct.
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 ms is a rare cause of benign obstructive jaundice triggered by impacted calculus in hartmann bag or cystic duct, causing extrinsic obstruction of the common hepatic duct. Type i includes partial or complete obstruction of the common hepatic duct due to external compression and type ii refers to the formation of a communication between the gallbladder neck or the cystic duct and the common hepatic duct. Mirizzis syndrome may be subdivided into types i and ii. Au binmoeller kf, thonke f, soehendra n so gastrointest endosc. In this study, ultrasonography and magnetic resonance cholangiopancreatography mrcp could have the suspicion of mirizzi syndrome in 77. The patient may present initially with colicky epigastric pain or manifest with. Oct 17, 2018 other types of mirizzi yndrome are relatively low in incidence.
Mirizzi syndrome, known as extrinsic bile compression syndrome, is a rare complication of cholecystitis and chronic cholelithiasis secondary to obliteration of the infundibulum of the gallbladder hartmanns pouch or cystic duct caused by the impact of one or more calculations in these anatomical structures. 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 is an unusual benign condition resulting from a chronically impacted stone in the neck of the gallbladder that itself compresses the common bile duct or that over time induces sufficient pericholecystic inflammation to obstruct the adjacent common hepatic duct or common bile duct. 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. Laparoscopic subtotal cholecystectomy for mirizzi syndrome. This occurrence is rare and, in english literature, three cases defined in children have been observed. Mirizzi type i, with a stone impacted in the neck of the gall bladder 7 or. In 2007, csendes adds a further type to the classification which was validated by beltran, this classification is. Mirizzi syndrome is defined as common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder. Todorov 3, 1 fellow, masters program in hepatobiliary pancreatic surgery, henri bismuth hepatobiliary institute, 1214, avenue paul vaillantcouturier, 94804 villejuif cedex. Mirizzi syndrome genetic and rare diseases information. The word syndrome comes from the greek word sundrom, which means concurrence of symptoms, or from word sundromos, which means running together.
Mirizzi syndrome is a rare pathological entity in the west with an incidence of less than 1% per year 3. Mirizzi syndrome is defined as common hepatic duct obstruction caused. Mirizzi syndrome is a rare complication of gallstone disease. As presented, this interesting patient fulfills the basic criteria for mirizzi s syndrome, an unusual complication of gallstone disease that occurs in only 0. Furthermore, it increases the risk of intraoperative biliary injury during cholecystectomy. Depending on the degree of involvement of the biliary tract, the patients may be grouped into five distinct groups according to the new rating of the mirizzi syndrome 1, 6. Mirizzis syndrome was described in 1948 and consists ofa stone impacted in the neckofthe gall bladder or in the cystic duct, causing inflammation and extrinsic compression of the commonduct, leading to obstructive jaundice. Mirizzi syndrome is the compressive blockage of the cystic or choledochal duct caused by a biliary stone occupying the cystic canal or hartmanns pouch. Laparoscopic management of type ii mirizzi syndrome.
It is a functional hepatic syndrome but can often present with biliary duct dilatation and can mimic other hepatobiliary pathologies such as. There was pus in the gall bladder, pericholeductal tissues were acutely inflamed. A gallstone gets impacted in the neck of the gallbladder called cystic duct or hartmanns pouch and compresses. According to the modified csendes classification, there are five different types of mirizzi syndrome. Mirizzi syndrome is characterized by increased occurrence of complications compared with routine surgery for cholecystolithiasis. Electrohydraulic lithotripsy has been shown to be an effective nonsurgical treatment for common bile duct and intrahepatic duct stones. Until recently open cholecystectomy was the standard of care for type ii mirizzi syndrome mcsherry classification. 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. Mirizzi syndrome type ii consists of a cholecystobiliary fistula resulting from erosion of the bile duct wall by a gallstone, the fistula must involve less than onethird of the circumference of the bile duct. Type i referred to compression of the common hepatic duct by a stone. Mirizzis syndrome treatment in india diagnosis of mirizzi.
In cases of intense inflammation, it is difficult to treat. The mirizzi syndrome refers to an uncommon phenomenon which results in extrinsic compression of an extrahepatic biliary duct from one or more calculi within the cystic duct or gallbladder. The most widely accepted classification of mirizzi syndrome was proposed by mcsherry et al. Mirizzi syndrome is a rare cause of obstructive jaundice.
Mirizzi syndrome is a rarely observed complication of gallstone disease, causing major biliary problems, if not diagnosed previously. Mirizzi syndrome is a rare complication of gallstone disease in which a gallstone becomes impacted in the cystic duct or neck of the gallbladder causing compression of the common bile duct cbd or common hepatic duct, resulting in proximal obstruction. As presented, this interesting patient fulfills the basic criteria for mirizzis syndrome, an unusual complication of gallstone disease that occurs in only 0. Mirizzi syndrome is a rare complication frequency about 1% of chronic cholecystitis and prolonged cholelithiasis, which consists of inflammatory process of gallbladder wall and direct compression mirizzi syndrome type i or erosion mirizzi syndrome type ii, iii, iv of the common bile duct and subsequent fistulous formation. In choledochoplasty, we the utilize a pedicled graft of gallbladder remnant in treatment of mirizzis syndrome 8, 9. Mirizzi syndrome new classification 2008 documento. Cholecystectomy also has been shown to be effective for type i mirizzi syndrome. A gallstone gets impacted in the neck of the gallbladder called cystic duct or hartmanns pouch and compresses the common bile duct cbd causing obstruction.
Surgical treatment is recommended for types iii and iv through the bilioenteric shunt or hepticostomy leaving a stent or a double t tube in place for a long period. Apr 05, 2020 mirizzi syndrome is a rare complication of gallstone disease. Current trends in the management of mirizzi syndrome ncbi. It occurs in less than 1% of all cholecystectomies3. America, mirizzi syndrome is a more common condition with a reported incidence ranging from 4. Type i mirizzi syndrome occurs when there is external compression on the common hepatic duct, whereas type ii mirizzi occurs when the impacted stone erodes.
Syndrome of inappropriate antidiuretic hormone secretion. The predominant cause for mirizzis syndrome is deemed to be cholecystitis which means inflammation of the gallbladder. Mirizzi syndrome is an uncommon complication of longstanding gallstone disease. It is a functional hepatic syndrome but can often present with biliary duct dilatation and can mimic other hepatobiliary pathologies such as cholangiocarcinoma 2. Mirizzis syndrome an overview sciencedirect topics. The obstructive jaundice can be caused by direct extrinsic compression by the stone or from fibrosis caused by chronic cholecystitis inflammation.
Mirizzi syndrome type ii consists of a cholecystobiliary fistula. The original classification, by mcsherry et al 5, described two types. Mirizzi syndrome can be divided into several types depending on the presence or absence of fistula and the size of the fistula. Mar 15, 2008 typical findings on us suggestive of mirizzi syndrome are a shrunken gallbladder, impacted stones in the cystic duct, a dilated intrahepatic tree, and common hepatic duct with a normalsized common bile duct. Preoperative diagnosis is challenging, and to date, there is no consensus on the standard management for this condition. 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 cbd common bile duct, resulting in cbd obstruction and jaundice. The diagnostic features on ultrasound are dilatation of the intra and extrahepatic bile ducts to the origin of the cystic duct or the neck of the gallbladder, were a gallstone can be found. Updates in mirizzi syndrome hepatobiliary surgery and. Todorov 3, 1 fellow, masters program in hepatobiliary pancreatic surgery, henri bismuth hepatobiliary institute. According to pathophysiological features, mirizzi syndrome can be classified into several different types. The chart showing pdf series, html series, scan qr codes html series. The importance and implications of this condition are. Patients with mirizzi syndrome can present with jaundice, fever, and right upper quadrant pain.
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