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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 bile duct (CBD) or 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 chronic cholecystitis (inflammation). A cholecystocholedochal fistula can occur.
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.
Multiple and large gallstones can reside chronically in the Hartmann's pouch of the gallbladder, causing inflammation, necrosis, fibrosis and ultimately fistula formation into the adjacent common bile duct (CBD). As a result, the CBD becomes obstructed by either scar or stone, resulting in jaundice. It can be divided into four types.
Type I - No fistula present
- Type IA - Presence of the cystic duct
- Type IB - Obliteration of the cystic duct
Types II-IV - Fistula present
- Type II - Defect smaller than 33% of the CBD diameter
- Type III - Defect 33-66% of the CBD diameter
- Type IV - Defect larger than 66% of the CBD diameter
Mirizzi 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 elevated bilirubin and alkaline phosphatase may or may not be present. Acute presentations of the syndrome include pancreatitis or cholecystitis.
Imaging by CT scan or ultrasonography usually make the diagnosis. Often, ERCP is used to define the lesion anatomically prior to surgery. MRCP is more often used to define the anatomy prior to surgery.
The treatment of choice is laparotomic surgical excision of the gallbladder, and reconstruction of the common hepatic duct and common bile duct.
- Vitale M. Mirizzi Syndrome Type IV: An Atypical Presentation That Is Difficult to Diagnose Preoperatively. 2009. Society for Surgery of the Alimentary Tract.http://www.ssat.com/cgi-bin/abstracts/09ddw/P7.cgi
- Hazzan, D; D Golijanin, P Reissman, SN Adler, E Shiloni (06 1999). "Combined endoscopic and surgical management of Mirizzi syndrome". Surgical Endoscopy 13 (6): 618–20. doi:10.1007/s004649901054. PMID 10347304.
- Ross, Jeffrey W; Gary S Sudakoff, Gregory B Snyder, Neela Lamki (editor), Bernard D Coombs (editor), Abraham H Dachman (editor), Robert M Krasny (editor), John Karani (editor) (2006-12-29). "Mirizzi syndrome". eMedicine. WebMD. Retrieved 2007-12-09.
- synd/3587 at Who Named It?
- Mirizzi PL: Syndrome del conducto hepatico. J Int de Chir 1948; 8: 731-77