A 70yearold woman was admitted for acute cholecystitis and choledocholithiasis with clinical deterioration after 12 h due to septic shock secondary to cholangitis. The mirizzi syndrome refers to benign obstruction of the common hepatic duct by a stone impacted within the neck or cystic duct of the gallbladder, which causes extrinsic compression of the common hepatic duct and obstructive jaundice. Mirizzis syndrome management this involves cholecystectomy plus common bile duct exploration with ttube placement. The association of mirizzi syndrome and gallbladder carcinoma gbc is not well understood. Here we describe the clinical case of a jaundiced patient from the ultrasound suspect of mirizzi syndrome to the surgical treatment. Given the patients clinical situation, a double pigtail plastic stent was implanted to alleviate. 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. Ultrasound showing features of mirizzi syndrome, a thick wall gallbladder with a large gallstone impacted in the hartmanns pouch. 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. Mirizzis syndrome treatment, classification, symptoms, types. 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. Pdf mirizzi syndrome is a rare complication of cholelithiasis, characterized by jaundice due to compression of the. Patients with mirizzi syndrome can present with jaundice, fever, and right upper quadrant pain.
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. Mrcp diagnosis of mirizzi syndrome in a paediatric patient. Colecistul sindromul mirizzi chirurgie ganduri, idei. Mirizzi syndrome is characterized by increased occurrence of complications compared with routine surgery for cholecystolithiasis. Mar 11, 20 1 post published by egichinasi during march 20. Mirizzi syndrome type iv associated with cholecystocolic. Mirizzi syndrome is a rare complication of cholelithiasis, with an estimated incidence of 0.
May 04, 20 we describe a 66yearold caucasian man with type 1 mirizzi syndrome diagnosed on endoscopic ultrasound. Mirizzi syndrome, cholelithiasis, surgical tratament. Fistula formation between the cbd and the gallbladder may represent an outcome of that condition. Mirizzis syndrome develops when a gallstone becomes impacted in the neck of the gallbladder or in the cystic duct causing compression of the common. Although a rare cause of obstructive jaundice, it remains a clinically and surgically challenging problem.
Mirizzi syndrome can be divided into several types depending on the presence or absence of fistula and the size of the fistula. Respiratorytriggered 3d mrcp was performed during free breathing. Other types of mirizzi yndrome are relatively low in incidence. 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. Computed tomography showing features of mirizzi syndrome, moderate to significant dilatation of intrahepatic biliary. Mirizzis syndrome may be mistaken for pancreatic cancer or cholangiocarcinoma p. An impacted gallstone was noted in the infundibulum. He presented with acute onset of jaundice, malaise, dark urine over 34 days, and was found to have obstructive jaundice on lab testing. Paciente do sexo masculino, 59 anos foi admitido no hospital universitario alcides carneiro apresentando ictericia obstrutiva, dor abdominal, acolia fecal, ascite, coluria e prurido por todo o corpo. 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. Am pomenit undeva in primele postari despre acest sindrom. 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 mirizzi syndrome is a rare disorder that usually presents with jaundice and cholangitis. Thieme ejournals zeitschrift fur gastroenterologie abstract. Mirizzi syndrome and gallbladder cancer springerlink. 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. It is a functional hepatic syndrome but can often present with biliary duct dilatation and can mimic other hepatobiliary pathology such as cholangiocarcinoma. S en d r o m e d e g o r l in s en d r o m e n e v o id e b. Mirizzi syndrome management in a department of general surgery. 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. Mirizzi syndrome is a rare complication of gallstone disease gsd. Urgent ercp detected dilatation of the proximal bile duct secondary to compression by a 2 cm calculus lodged in the cystic duct. Lawrence munson, mda department of general surgery, lahey clinic medical center, tufts. Il codice alla base della razza umana, il suo dna, e concentrato essenzialmente in 46 cromosomi. Ut health san antonio general surgery grand rounds 2,232 views. It presents as a spectrum of disease that varies from extrinsic compression of the common hepatic duct to the presence of a cholecystobiliary fistula.
The obstructive jaundice can be caused by direct extrinsic compression by the stone or from fibrosis caused by chronic cholecystitis inflammation. The mirizzi syndrome was described by pablo luis mirizzi in 1948, who emphasized this syndrome was characterized by the obstruction of the common hepatic duct due to mechanical compression caused by an impacted stone in the gallbladder neck or in the cystic duct. We report a 15yearold boy with mirizzi syndrome diagnosed by mr cholangiopancreatography mrcp. As presented, this interesting patient fulfills the basic criteria for mirizzi s syndrome, an unusual complication of gallstone disease that occurs in only 0. Septic shock secondary to mirizzi syndrome resolved in two. 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. 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. The surgical treatment of the mirizzi syndrome requires ability and care in the dissection of the biliary tract in order to perform the cholecystectomy, a safe operation of the biliary tract can be avoided and the removal of the calculus so can avoid any iatrogeny in the biliary tract, as in this particular case, where was opted to dissect the biliary tract incompletely through the torek. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Pdf mirizzi syndrome is a rare complication of cholelithiasis, characterized by jaundice due to compression of the bile duct. Mirizzi syndrome is a rare cause of obstructive jaundice.
1270 1565 750 293 126 386 845 932 391 1469 1543 31 786 62 939 8 165 1280 471 101 36 524 13 1021 1388 822 438 1345 1162 893 1496 934 1273 979 888 838 287 819 1256