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 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. Mirizzis syndrome an overview sciencedirect topics. Mirizzi syndrome medigoo health medical tests and free.
The aim of this paper is to report five cases and describe the pitfalls encountered in its diagnosis and treatment with a laparoscopic approach. Kontic4,gezasmit1 1department of surgery, regional hospital, zrenjanin, serbia 2institute for hygiene and nutrition, medical faculty, belgrade, serbia. Mirizzi syndrome ms in association with biliaryenteric fistula is an extremely rare combination. Start studying bile duct injury and mirizzi syndrome. Rhd and lhd merge to form the common hepatic duct chd. 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. Jul 30, 2017 posts about mirizzi syndrome written by simply radiology. Primary cause for this is complicated cholecystitis with gallstone impacted in thehartmanns pouch, also known as mirizzi syndrome. Meige syndrome nord national organization for rare. Remote work advice from the largest allremote company. We report our experience of gallbladder carcinoma in patients with mirizzi syndrome. Left graphic of mirizzi syndrome depicts a large cystic duct stone causing extrinsic compression of the common hepatic duct chd and dilation of the intrahepatic bile ducts. Management of post cholecystectomy mirizzis syndrome janes s. 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.
Many surgical approaches of varying complexity have been advocated for treatment. Mirizzi syndrome, common hepatic duct fistula, left hepatic atrophy, left. Pdf surgical management of mirizzi syndrome unal aydin. It is a functional hepatic syndrome but can often present with biliary duct dilatation and can mimic other hepatobiliary pathologies such as cholangiocarcinoma 2. The mirizzi syndrome ms, a rare condition, is a late complication of chronic cholecystitis.
In 1 case, ultrasound suggested mirizzi syndrome and percutaneous cholangiography and computed tomography which confirmed the diagnosis. Mri t2 imaging features of this case are in keeping with calculous cholecystitis, with mirizzi syndrome and hepatic abscess present. The definitive diagnosis for these two rare internal fistulas was reached preoperatively, by ercp. Its more frequent on women between 21 to 90 years old, probably a reflection of the gallstones preponderance in this group. 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. With higher incidence in central andsouth america where the reported incidenceis 4. Mirizzi syndrome ms is a rare complication of cholelithiasis with an estimated incidence of 0. Mirizzi syndrome, also known as extrinsic biliary compression syndrome.
Mirizzis syndrome masquerading as cholangiocarcinoma. 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 treatment, classification, symptoms, types. The diagnosis of this syndrome is of importance because surgery in its presence is associated with an increased incidence of bile duct. However, the distorted extrahepatic biliary anatomy continues to be threatening, with a high risk of biliary complications. The association of mirizzi syndrome and gallbladder carcinoma gbc is not well understood. Mirizzi syndrome is a complication of long standing cholelithiasis. Benign obstruction of the common hepatic duct mirizzi.
This study aims to evaluate the treatment approach by analysing the diagnostic method and the outcome of surgical treatment in our hospital. It is also known as brueghels syndrome and oral facial dystonia. Situation awareness for impending danger in hostile abdomen with severe inflammation eg, fusion of bile duct to inferior edge of gb wall, adhesions pull hartmanns pouch toward the cbd, creating a short cystic duct after recurrent attacks, fibrosis of periductal tissues, mirizzi syndrome. Identification of mirizzi s syndrome preoperatively will enable careful planning of the surgical procedure and reduces associated morbidity. If the signs of cholestasis occur, may be due to choledocolithiasis, cholangitis, or the mirizzi syndrome. Management of mirizzi syndrome in gastroenterology. A collection of disease information resources and questions answered by our genetic and rare diseases information specialists for mirizzi syndrome. Furthermore, it increases the risk of intraoperative biliary injury during cholecystectomy. 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. Various strategies have been proposed for the management of retained calculi within the biliary tree following cholecystectomy. Many surgeons claim that laparoscopic cholecystectomy is contraindicated in mirizzi.
Mirizzi syndrome is a rarely observed complication of gallstone disease, causing major biliary problems, if not diagnosed previously. 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. Mirizzi syndrome genetic and rare diseases information. This can create major difficulty during a cholecystectomy. The clinical presentation of mirizzi syndrome ranges from asymptomatic to nonspecific, with obstructive jaundice 27. Environmental education resources to commemorate earth days 50th anniversary. Cholelithiasis is commonly known as gallstone which directly means stone in the gallbladder.
Gianfranco mirizzi digital arts video installation. The mirizzi syndrome is a rare disorder that usually presents with jaundice and cholangitis. Systems and methods display at least one subject, and display a location for at least one user to enter at least one problem related to the subject. Ultrasound showing features of mirizzi syndrome, a thick wall gallbladder with a large gallstone impacted in the hartmanns pouch. Mirizzi s syndrome ms is an unusual cause of obstructive jaundice. The description of a man with erythrocytosis and perinephric fluid collections recently appeared in the case records of the massachusetts general hospital1 patient 1 in table 1, an. This study aimed to analyze the diagnostic methods, operative strategies, and outcome of the surgical treatment of patients with mirizzi syndrome. To our knowledge there is only one report that refers to the rare coexistence of mirizzi syndrome type ii with a parapapillary choledochoduodenal fistula. 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. 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. Endoscopic treatment includes biliary drainage and stone extraction. Because ofthe surgical implications ofthe mirizzi syndrome, it is particularly important that the biliary anatomy is adequately defined before surgery. 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.
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. 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. Mirizzi syndrome is a rare complication of cholelithiasis, with an estimated incidence of 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. Also, gall bladder cancer shares some of the clinical and radiological features and could coexist 3 with mirizzi s syndrome adding an extra challenge and highlighting the importance. In our series the frequency of mirizzi syndrome was 0. Mirizzis syndrome is a rarely observed disorder that presents with obstructive jaundice. Postlaparoscopic cholecystectomy mirizzi syndrome induced by polymeric. As presented, this interesting patient fulfills the basic criteria for mirizzi s syndrome, an unusual complication of gallstone disease that occurs in only 0. Mirizzi s syndrome is a partial obstruction of the biliary tree caused by a stone impacted in the cystic duct, with or without development of a cholecystobiliary fistula. Click on the link to view a sample search on this topic. Appraisal of diagnosis and surgical approach for mirizzi.
Learn vocabulary, terms, and more with flashcards, games, and other study tools. The condition is often confused with other serious conditions such as hilar cholangiocarcinoma, which present with similar. Open cholecystectomy is the gold standard for treatment when this condition is. Todorov 3, 1 fellow, masters program in hepatobiliary pancreatic surgery, henri bismuth hepatobiliary institute, 1214, avenue paul vaillantcouturier, 94804 villejuif cedex.
Current trends in the management of mirizzi syndrome. Combined endoscopic and surgical management of mirizzi. The tempi syndrome a novel multisystem disease nejm. The disease can mimic cancer of the gallbladder, causing considerable diagnostic difficulties. It is more common in females between 21 to 90 years old 1. Mirizzi syndrome is a form of obstructive jaundice caused by a stone impacted in the gallbladder neck or the cystic duct that impinges on the common hepatic duct with or without a cholecystocholedochal fistula. Mirizzi syndrome is an unusual benign condition resulting from a chronically. In cases of intense inflammation, it is difficult to treat. Role of robotic surgery in the treatment of mirizzi syndrome. Here we describe the clinical case of a jaundiced patient from the ultrasound suspect of mirizzi syndrome to the surgical treatment. Mirizzi syndrome is a rare complication and it occurs approximately on 0. In patient 4, the diagnosis was made based on the combination of mrcp and ertcp. Mirizzi syndrome ms is an uncommon complication of longterm chronic cholecystitis, characterized by extrinsic compression of the common hepatic duct or the presence of cholecystobiliary fistula. Mirizzi syndrome is a rare complication of long standing cholelithiasis which occurs in 0.
Dystonia is a group of movement disorders that vary in their symptoms, causes, progression, and treatments. This syndrome is a rare complication of cholelithiasis that accounts for 0. The mirizzi syndrome major cause for biliary duct injury during laparoscopic cholecystectomy. Although a rare cause of obstructive jaundice, it remains a clinically and surgically challenging problem. A case series report wei han,1 qing yue,2 kai liu,1 jianji ke,1 lingyu meng,1 and yahui liu 1 1department of hepatobiliary and pancreatic surgery, the first hospital of jilin university. The mirizzi syndrome major cause for biliary duct injury. Mirizzi syndrome is an important and rare complication of gallstone disease. Pdf the mirizzis syndrome is an uncommon condition. This group of neurological conditions is generally characterized by involuntary muscle contractions that force the body into abnormal, sometimes painful, movements and. S u r g e ry and o f n a l es n th u o r aeis journal of. Mirizzi syndrome is a rare complication of prolonged cholelithiasis, characterized by narrowing of the common hepatic duct due to mechanical compression andor inflammation due to biliary calculus impacted in the infundibula of the gallbladder or in the cystic duct. Pdf mirizzi syndrome with type f bile duct anomalya rare case. Right coronal t2wi mr shows subtle intrahepatic bile duct dilation and a large gallstone impacted within the neck of the gallbladder gb, causing extrinsic narrowing. Hepatobiliary and hepatic vascular anatomy evaluated with.
The mirizzi syndrome develops as a result of the acute andor chronic inflammatory processes that follow the impaction of either a large. 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 and presents unusual lodged gallstone in either the cystic duct or most frequently in hartmann pouch of the gallbladder. Laparoscopic surgery for type i mirizzi syndrome with acute cholecystitis.
Mirizzi syndrome or extrinsic biliary compression syndrome, is a rare complication of cholelithiasis. It can mimic bile duct cancer, and the role of laparoscopic surgery is not well defined. The problem comprises unknown items to which the user would like more information. 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. A case of type iv ms, with extensively damaged common hepatic duct chd due to gallstone impaction and fistula, was effectively treated by minilaparoscopic hepaticoduodenostomy hd. Mirizzi syndrome type iii consists of a cholecystobiliary fistula involving up to twothirds of the bile duct circumference. Pdf mirizzi syndrome, known as extrinsic bile compression syndrome, is a rare complication of. Mirizzi syndrome type iv associated with cholecystocolic. Case report open access mirizzi syndrome with an unusual type of biliobiliary fistulaa case report tsutomu kawaguchi1,2, tadao itoh2, kazuhiro yoshii2 and eigo otsuji1 abstract gallstone obstruction of the cystic duct, resulting in chronic cholecystitis and pressure necrosis leads to the. Duct joining cystic duct type f anomaly with mirizzi syndrome csendes type 3. Clinical study on causative factors and recurrence of choledocholithiasis clinical study on causative factors and recurrence of. 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. When mirizzi syndrome is discovered intraoperatively, the rate of conversion to open procedure and duct injury increase dramatically with one group reporting 100% conversion rates 11.
Computed tomography showing features of mirizzi syndrome, moderate to significant dilatation of intrahepatic biliary. Patients with mirizzi syndrome can present with jaundice, fever, and right upper quadrant pain. 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. A series reporting laparoscopic cholecystectomy in mirizzi syndrome had a conversion rate as high as 31% to 100%, with a complication rate of 0% to 60%, bile duct injury of 0% to 22% and mortality ranging from 0% to 25% 6, 28, 55, 56, 61. Mirizzi syndrome is a rare complication of gallstone disease, with a reported incidence between 0. We present a unique case of a cystic duct remnant calculus causing mirizzi syndrome, only the fourth such case of its kind. Mirizzi syndrome and gallbladder cancer springerlink. It is actually a combination of two forms of dystonia, blepharospasm and oromandibular dystonia omd. Mirizzi syndrome is an uncommon cause of obstructive jaundice characterized by impacted gallstone in cystic duct or gallbladder neck with associated inflammatory changes causing external compressive narrowing of common hepatic duct and. When omd is combined with blepharospasm, it may be referred to as meiges syndrome named after henri meige, the french neurologist who first described the symptoms in detail in 1910. Laparoscopic subtotal cholecystectomy for mirizzi syndrome.
We retrospectively analysed the data of 198 patients with mirizzi syndrome between january 2004 and january 2010. Mirizzi syndrome with type f bile duct anomaly medwin publishers. Mirizzi syndrome with an unusual type of biliobiliary. An exaggerated form of the same process is the mirizzis syndrome in which a large stone in the hartmanns pouch area is either adherent to or erodes into the bile duct. 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.
The obstructive jaundice can be caused by direct extrinsic compression by the stone or from fibrosis caused by chronic cholecystitis. Pubmed is a searchable database of medical literature and lists journal articles that discuss mirizzi syndrome. It is a spectrum of disease ranges from simple compression of common hepatic duct to cholecystobiliary fistula cbf. Mergers offer an example of such changes, when subgroups merger partners merge into a common, superordinate group post. 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. Mirizzi syndrome, laparoscopic treatment, diagnosis. Mirizzi syndrome is an unusual presentation of prolonged cholelithiasis.
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