14 Sep Chronic complications of symptomatic gallstone disease, such as Mirizzi syndrome, are rare in Western developed countries with an incidence. 17 Oct Mirizzi syndrome is an unusual presentation of obstructive jaundice caused by extrinsic compression of an extrahepatic biliary duct from one or. The Mirizzi syndrome refers to an uncommon phenomenon which results in extrinsic compression of an extrahepatic biliary duct from one or more calculi within.

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The constant compression of the calculus associated to the inflammation of the involved structures may result in fistula between the gallbladder infundibulum or the cystic duct, and the extra hepatic biliary tract.

Synonyms or Alternate Spellings: Surgical treatment of Mirizzi syndrome includes the following important steps: Three highly sensitive and specific signs noted are a nonvisualized gallbladder, moderate dilatation of the common hepatic duct CHDand delayed excretion into the duodenum. Syndromes affecting the hepatobiliary mirozzi. However, MRCP is not efficient at localizing a cholecystocholedochal fistula.

Mirizzi syndrome: a surgical challenge

Endoscopic management of Mirizzi syndrome. The pathophysiology of biliary obstruction and its effect on phagocytic and immune functions. All the contents of this journal, except where otherwise noted, is ssindrome under a Creative Commons Attribution License. The objective of this study was to describe a series morizzi eight patients with Mirizzi syndrome, submitted to surgical treatment, and to comment on aspects of the etiopathogenesis and clinical presentation, with emphasis on the diagnosis and treatment of this complication of biliary lithiasis.

Mirizzi’s syndrome occurs in approximately 0. The importance of the recognition the Mirizzi syndrome derives from the high risk of lesions of the biliary duct during the surgical procedures.


Considering the sample size, data are given as the percentage and mean. It affects males and females equally, but tends to affect older people more often. Salim MT, Cutait R.


Although jaundice and or alterations in the serum tests of hepatic function without macroscopic liver abnormalities occurred in five patients in this series, they were not submitted to intra-operative hepatic biopsy. Services on Demand Journal. Reid-Lombardo and Michael B.

Diagnosis and treatment of Mirizzi syndrome: 23-year Mayo Clinic experience.

Management of Mirizzi syndrome in the laparoscopic era. Thank you for updating your details.

An impacted calculus in the Hartmann pouch or the cystic duct. The major factor for the successful treatment of Mirizzi syndrome is mirlzzi precocious recognition, even in the intra-operative, and on the modification of the management, according to the characteristics of each case.

How it could be a challenge. For this reason, the disease represents a dangerous alteration in the anatomy during the performance of cholecystectomy, by predisposing the patients to the risk of an inadvertent re of the common hepatic duct 14, 18, The importance of the recognition the Mirizzi syndrome derives from the high risk of lesions of the biliary duct during the surgical procedures.

Mirizzi syndrome is characterized by increased occurrence of complications compared with routine surgery for cholecystolithiasis. Showing of 23 extracted citations. Due to the hypersecretion of bilirubin, precipitation of calcium bilirubinate begins in bile 3, 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 16.

Surg Laparosc Endosc Percutan Tech. All the patients were white. For the reconstruction of the biliary duct in the Mirizzi syndrome type IV, a choledochal and hepaticojejunal anastomosis sndrome Roux-en-Y is usually necessary as a first act, as in the case of the patient here reported 6 Mirizzi syndrome is a rare complication and it occurs approximately on 0.

Zhong H, Gong JP. Check for errors and try again. Benign Obstruction of the common hepatic duct Mirizzi Syndrome: Videolaparoscopy complications in the management of biliary diseases. The diagnosis can be suggested when US or abdominal CT features reveal biliary stones in the junction of the cystic and common hepatic ducts and associated to dilation proximal to the biliary tree 8.


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However, a dilated cystic duct can be confused with the common hepatic duct of normal diameter 25thereby hindering the diagnosis of this condition. One patient case 1 presented jaundice and diffusely nodular and firm surface of the liver at laparotomy, an intra-operative hepatic dd was performed that revealed a chronic alcoholic hepatopathy. Endoscopic treatment of Mirizzi syndrome.

However, conventional laparotomy is usually necessary for the correction of cholecystocholedochal fistula Validation of a Modified Classification. Cavalcanti JS, et al. Case 3 Case 3. Surgical management of Mirizzi syndrome. Surg Laparoc Endosc ;5: That nonconjugative mono-hydrogenated bilirubin is formed by the endogenous enzymatic action of a b -glycuronidase.

The organs that can be involved in the cholecystoenteric fistula are the stomach, the duodenum and the colon.

How to cite this article. Using the infundibula of the gallbladder close to the orifice in the common hepatic duct has the advantage that it constitutes vascular tissue mirzizi has a mucous membrane similar to that of the xe duct In fact, chronic hepatopathy can lead to the formation of biliary calculus due to the hypersecretion of bilirubin and especially excess of monoglycuronil-bilirubin.

His pain resolved over a few days, but mildly elevated bilirubin levels persisted. Cavalcanti JS, et al. Multiple and large gallstones can become impacted in the Hartmann’s pouch of the gallbladderleading to chronic inflammation – which leads to compression of the common bile duct CBDnecrosisfibrosis, and ultimately fistula formation into the adjacent common hepatic duct CHD or sindome bile duct CBD.