According to mirizzi s classification and csendess subclassification, mirizzi syndrome type iv. Mirizzi syndrome is a rare complication of gallstone disease in which a gallstone becomes impacted in the cystic duct or neck of the gallbladder c. Mirizzi and presents unusual lodged gallstone in either the cystic duct or most frequently in hartmann pouch of the gallbladder. This case illustrates the utility of 3d mrcp with parallel imaging in. Mrcp diagnosis of mirizzi syndrome in a paediatric patient. Although a rare cause of obstructive jaundice, it remains a clinically and surgically challenging problem. Respiratorytriggered 3d mrcp was performed during free breathing. As presented, this interesting patient fulfills the basic criteria for mirizzi s syndrome, an unusual complication of gallstone disease that occurs in only 0. We report a 15yearold boy with mirizzi syndrome diagnosed by mr cholangiopancreatography mrcp. The patient may present initially with colicky epigastric pain or manifest with hyperbilirubinemia jaundice.
The patient may present initially with colicky epigastric pain or manifest with. Type 1 mirizzi syndrome refers to extrinsic compression of the cbd with intact 1a or obliterated 1b cystic duct without a cholecystocholedochal fistula. Mirizzi syndrome is a complication of long standing cholelithiasis. The initial surgical approach was carried on by laparoscopic via that confirmed. Pdf backgroundsaims mirizzi syndrome ms is an uncommon complication of cholelithiasis. Mirizzi syndrome is a disease with low prevalence, which must be taken into account in biliary surgery, because the treatment varies according to the intraoperative findings and the experience of. 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. Mirizzi was the first to describe an obstructive jaundice caused by compression of the common hepatic duct by the stone in the cystic duct or the neck of the gallbladder bibliography p.
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. Mirizzi syndrome tends to affect older patients it is named after pablo mirizzi, an argentinean physician. Study 59 terms gallbladder test questions flashcards. 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.
Color parameter was evaluated as 1 point lightbrown, darkbrown, black, red. Mirizzis 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. Classification proposal and surgical treatment of mirizzi syndrome. Mirizzi syndrome is a rare cause of obstructive jaundice. Fistula formation between the cbd and the gallbladder may represent an outcome of that condition. Lawrence munson, mda department of general surgery, lahey clinic medical center, tufts. Learn vocabulary, terms, and more with flashcards, games, and other study tools. A pediatric patient presents with pain, intermittent jaundice, and a palpable mass. Apr 12, 20 mirizzi syndrome is a rare complication of gallstone disease in which a gallstone becomes impacted in the cystic duct or neck of the gallbladder c.
It is a functional hepatic syndrome but can often present with biliary duct dilatation and can mimic other hepatobiliary pathologies such as. Mirizzis syndrome is a rare complication in which a gallstone becomes impacted in the cystic. Mirizzi syndrome is an unusual presentation of obstructive jaundice caused by extrinsic compression of an extrahepatic biliary duct from one or more calculi within the cystic duct or gallbladder. Surgical neurology international an open access, international journal of neurosurgery and neuroscience surgical neurology international v olume 2 issue 3 mayjun 201 1 pages 309508 julaug 2011 vol 2 issue 4. Accompanying features can be fever and right upper quadrant pain. The obstructive jaundice can be caused by direct extrinsic compression by the stone or from fibrosis caused by chronic cholecystitis inflammation. Mirizzi syndrome is a rare complication of prolonged. Altered biliary tract anatomy and the associated pathology make cholecystectomy, open or laparoscopic, a formidable undertaking. May 04, 20 mirizzi syndrome has been classified into four types. Mirizzi syndrome type ii with a gastric antrum erosion.
Pdf mirizzi syndrome type iv is an extremely rare condition, which is confused with the diagnosis of cholangiocarcinoma in many cases. Impacted stone in the cystic duct, cystic duct remnant, or gb neck. As presented, this interesting patient fulfills the basic criteria for mirizzis syndrome, an unusual complication of gallstone disease that occurs in only 0. Here we describe the clinical case of a jaundiced patient from the ultrasound suspect of mirizzi syndrome to the surgical treatment. Surgical neurology international hospital italiano. Dec 23, 2008 mirizzi syndrome is a complication of long standing cholelithiasis. An impacted gallstone was noted in the infundibulum.
The diagnosis of mirizzi syndrome was intraoperative in seven 87. Thieme ejournals zeitschrift fur gastroenterologie abstract. Discussion mirizzi syndrome is a rare complication of gallstones and occurs in approximately 0. Parital mechanical obstruction of the chd by compression of inflammatory reaction around an impacted stone will cause symptoms. A sono is performed and a large cystic mass is seen in the portal hepatic region with dilatation of the chd and cbd. 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 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. Mirizzi s syndrome on the web most recent articles.
The mirizzi syndrome is a rare disorder that usually presents with jaundice and cholangitis. Oct 17, 2018 mirizzi syndrome is an unusual presentation of obstructive jaundice caused by extrinsic compression of an extrahepatic biliary duct from one or more calculi within the cystic duct or gallbladder. Mirizzi syndrome has been classified into four types. Mirizzi syndrome is a rarely observed complication of gallstone disease, causing major biliary problems, if not diagnosed previously. Three other types have a cholecystocholedochal fistula and vary in terms of size, expressed as percentage of the cbd width. According to mirizzis classification and csendess subclassification, mirizzi syndrome type.
Altered biliary tract anatomy and the associated pathology make cholecystectomy, open or laparoscopic, a formidable. 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 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. Acute acalculous cholecystitis determining mirizzi syndrome. 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. What links here related changes upload file special pages permanent link page. Benign obstruction of the common hepatic duct mirizzi syndrome. 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.
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