scholarly journals The Current Approach to the Diagnosis and Classification of Mirizzi Syndrome

Diagnostics ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. 1660
Author(s):  
Jakub Klekowski ◽  
Aleksandra Piekarska ◽  
Marta Góral ◽  
Marta Kozula ◽  
Mariusz Chabowski
Keyword(s):  
Hepatic Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
High Sensitivity ◽  
Current Approach ◽  
Mirizzi Syndrome ◽  
Common Hepatic Duct ◽  
Diagnostic Challenge ◽  
External Compression ◽  
Gradual Process ◽  
New Research

Mirizzi syndrome occurs in up to 6% of patients with cholecystolithiasis. It is generally caused by external compression of the common hepatic duct by a gallstone impacted in the neck of the gallbladder or the cystic duct, which can lead to fistulisation. The aim of this review was to highlight the proposed classifications for Mirizzi syndrome (MS) and to provide an update on modern approaches to the diagnosis of this disease. We conducted research on various internet databases and the total number of records was 993, but after a gradual process of elimination our final review consisted of 21 articles. According to the literature, the Cesendes classification is the most commonly used, but many new suggestions have appeared. Our review shows that the ultrasonography (US) is the most frequently used method of initial diagnosis, despite still having only average sensitivity. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) are good methods and are similarly effective, but only the latter can be simultaneously therapeutic. Some modern methods show very high sensitivity, but are not so commonly administered. Mirizzi syndrome is still a diagnostic challenge, despite the advancement of the available tools. Preoperative diagnosis is crucial to avoid complications during treatment. New research may bring a unification of classifications and diagnostic algorithms.

scholarly journals Mirizzi syndrome complicated by common hepatic duct fistula and left hepatic atrophy: a case report

2018 ◽  
Vol 46 (11) ◽  
pp. 4806-4812 ◽  
Author(s):  
Jiang Zhou ◽  
Rui Xiao ◽  
Jing-rui Yang ◽  
Lu Wang ◽  
Jia-xing Wang ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Hepatic Duct ◽  
Rare Complication ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Mirizzi Syndrome ◽  
Fistula Formation ◽  
Common Hepatic Duct ◽  
Asian Woman ◽  
Calot’S Triangle ◽  
Hepatic Atrophy

Background Mirizzi syndrome is a rare complication of chronic cholecystitis, usually caused by gallstones impacted in the cystic duct or the neck of the gallbladder. Mirizzi syndrome results in compression of the hepatic duct or fistula formation between the gallbladder and common bile duct (or hepatic duct, right hepatic duct, or even mutative right posterior hepatic duct). Clinical features include abdominal pain, fever, and obstructive jaundice. Severe inflammation and adhesion at Calot’s triangle are potentially very dangerous for patients with Mirizzi syndrome undergoing cholecystectomy. Case presentation: We report the case of a 68-year-old Asian woman who presented with abdominal pain and jaundice. She had a medical history of gallstones, but no fever. Magnetic resonance cholangiopancreatography revealed cholecystitis, cholelithiasis, common hepatic duct stones, and ascites. Findings at surgery included a porcelainized, atrophic gallbladder that was full of gallstones, fistula formation between the gallbladder and common hepatic duct, and left hepatic atrophy. The prominent feature was the left hepatic atrophy, but stones were not visible pre-operatively in the left liver by radiologic examination. Conclusions This patient exhibited what can be considered a special type II of Mirizzi syndrome with a fistula of the common hepatic duct as well as left hepatic atrophy.

Clinical aspects and surgical technique in Mirizzi syndrome: A systematic review

2020 ◽  
pp. 35871-35873
Keyword(s):  
Surgical Technique ◽  
Cystic Duct ◽  
Hepatic Duct ◽  
Signs And Symptoms ◽  
Mirizzi Syndrome ◽  
Common Hepatic Duct ◽  
Clinical Aspects ◽  
Main Diagnosis ◽  
Biliary Surgery ◽  
Electronic Library

Mirizzi syndrome is described in the 1940s as follows: partial obstruction of the secondary common hepatic duct by gallstones, impacted on the cystic duct or gallbladder infundibulum, associated with the inflammatory response that involved the cystic duct and the common hepatic duct. As it is a rare and delicate condition, differential diagnosis is extremely important, in which the patient's clinical condition is verified through anamnesis and complementary exams, where immediately after the surgical intervention can be performed. This work aims to describe, through a literature review, the clinical aspects and the surgical technique in Mirizzi Syndrome. Were used as a database for research sites containing scientific articles available online such as Virtual Health Library (VHL), Scientific Electronic Library Online (Scielo) and PubMed. 154 articles were found through the descriptors, where after applying the inclusion and exclusion criteria 11 articles remained to write the work. According to the articles surveyed, it is clear that most of them do not report the syndrome as the main diagnosis, possibly because it is a pathology with signs and symptoms very close to other diseases of the bile duct, therefore leaving the syndrome sometimes described in the context of these other diseases. Finally, it concludes that even though the preoperative diagnosis is rare, it should be suspected in individuals undergoing biliary surgery.

scholarly journals Type VI Choledochal Cysts—Case Report and Review of Literature

2019 ◽  
Vol 05 (03) ◽  
pp. e82-e86 ◽  
Author(s):  
J. M. V. Amarjothi ◽  
Villalan Ramasamy ◽  
Jeyasudhahar Jesudasan ◽  
O. L. NaganathBabu
Keyword(s):  
Hepatic Duct ◽  
Treatment Options ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Interesting Case ◽  
Common Hepatic Duct ◽  
Choledochal Cysts ◽  
Middle Aged ◽  
Complete Excision ◽  
Intrahepatic Bile Ducts ◽  
Aged Woman

AbstractCholedochal cysts (CDC), are rare congenital dilations involving the extra hepatic biliary apparatus with or without dilation of the intrahepatic bile ducts. They are conventionally classified into five types. A new type, type VI, causing dilation of the cystic duct between the neck of the gall bladder and the common hepatic duct (CHD) has been described in medical literature which is the rarest of all these subtypes. They are commonly observed in middle aged females and are mostly symptomatic. Most of these cysts need magnetic resonance cholangiopancreatography (MRCP) for accurate diagnosis. Treatment options for these lesions are not well defined but range from simple cholecystectomy to complete excision of the entire bile duct and biliary reconstruction, as there is a concern of malignant transformation in these cysts. Hence, these rare cysts, though rare, must be borne in mind when dealing with suspicious cystic lesions in the biliary tract. Here, we present an interesting case of such a rare cyst and its management in a middle aged woman.

The Value of Cholangiography through Jackson-Pratt Drains in the Management of Postoperative Biliary Injuries

2014 ◽  
Vol 80 (1) ◽  
pp. 66-71 ◽  
Author(s):  
Francisco Igor B. Macedo ◽  
Victor J. Casillas ◽  
James S. Davis ◽  
Joe U. Levi ◽  
Danny Sleeman
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hepatic Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Common Hepatic Duct ◽  
Biliary Reconstruction ◽  
Biliary Injury ◽  
Endoscopic Retrograde ◽  
Distal Common Bile Duct ◽  
Potential Benefits

Iatrogenic biliary injury is the most significant complication after laparoscopic cholecystectomy. We present our experience with an alternative diagnostic approach using transcatheter cholangiography (TCC) through a Jackson-Pratt (JP) drain and discuss potential benefits and limitations of the technique. From March 2002 to February 2012, 40 patients with major postoperative biliary injury underwent biliary reconstruction at our institution. Mean age was 51.7 ± 18.1 years (range, 19 to 86 years) with 30 (75%) females. Seventeen (42.5%) injuries were detected intraoperatively and in 13 (32.5%) cases, JP drains were placed for biliary drainage. Lesions were classified according to Bismuth grade: I (10 patients [25%]), II (10 patients [25%]), III (six patients [15%]), IV (10 patients [25%]), and V (four patients [10%]). TCC was performed in seven patients with JP drains (53.8%). It fully defined the injury site in three cases of limited magnetic resonance cholangiopancreatography (MRCP) such as common hepatic duct and common bile duct leaks and in four cases (57.1%) that endoscopic retrograde cholangiopancreatography (ERCP) was limited as a result of clipping of the distal common bile duct. TCC showed promising results in cases of limited MRCP and ERCP such as fistulous orifices or leakage. It may represent an alternative adjunct in the diagnostic armamentarium of complex biliary injuries.

scholarly journals Hepatolitiasis: Kasus Serial di RSUD Dr. Soetomo

2018 ◽  
Vol 2 (1) ◽  
pp. 5 ◽  
Author(s):  
Made Mahayasa ◽  
Tommy Lesmana
Keyword(s):  
Bile Duct ◽  
Magnetic Resonance ◽  
Common Bile Duct ◽  
Gall Bladder ◽  
Hepatic Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Common Hepatic Duct ◽  
Hepatic Bile ◽  
Hepatic Bile Duct

Latar Belakang: hepatolitiasis adalah batu empedu pada saluran empedu liver dengan insidensi 20-30% dari semua pasien yang menjalani operasi untuk penyakit batu empedu. Ada beberapa pilihan operasi hepatolitiasis, seperti hepatektomi, eksplorasi common bile duct (CBD), dan drainase saluran intrahepatik atau cholangioenterostomy (access loop procedures), dan teknik perkutaneus. Pada laporan kasus serial ini, akan dibahas aspek pemilihan operasi pada pasien dengan hepatolitiasis. Kasus: kasus pertama adalah laki-laki, 60 tahun, dirawat di Rumah Sakit Dr. Soetomo dengan nyeri abdomen kuadran kanan atas sejak 2 minggu. Diagnosis dengan USG (ultrasonografi) abdomen dan MRCP (magnetic resonance cholangiopancreatography) menunjukkan terdapat beberapa batu di IHBD (intra hepatic bile duct), CHD (common hepatic duct), CBD, GB (gall bladder), dan sistem bilier yang melebar. Pada pasien dilakukan tindakan kolesistektomi, eksplorasi duktus, dan by pass bilio-digestive Roux en Y (access loop procedures). Kasus kedua adalah perempuan, 45 tahun, dirawat di Rumah Sakit Dr. Soetomo dengan didiagnosis batu IHBD dan CBD. Penderita telah dilakukan kolesistektomi sejak 12 tahun yang lalu. Durante operasi ditemukan atrofi lobus kiri hati. Pada pasien, dilakukan operasi dengan eksplorasi duktus, by pass bilio-digestive Roux en Y (access loop procedures), dan hepatektomi lobus kiri. Simpulan: kasus hepatolitiasis jarang terjadi di Rumah Sakit Dr. Soetomo Surabaya. Diagnosis lengkap memerlukan kombinasi modalitas pencitraan. Pembedahan tetap menjadi pilihan utama pengobatan definitif. Menurut strategi terapeutik saat ini untuk hepatolitiasis, hepatektomi tampaknya merupakan pengobatan yang paling efektif untuk pasien dengan hepatolitiasis kiri yang terisolasi jika prosedur pembedahan lain tidak dapat mengatasi semua lesi terkait. Perawatan yang baik dapat memberikan luaran yang baik.

scholarly journals Congenital biliary web- a rare cause of obstructive jaundice in an infant: A case report

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Allah Ditta ◽  
Muhammad Bilal Mirza ◽  
Muhammad Waqas-ur-Rehman ◽  
Maria Fahim ◽  
Farrakh Mehmood Satar ◽  
...  
Keyword(s):  
Obstructive Jaundice ◽  
Hepatic Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Biliary Tree ◽  
Postoperative Recovery ◽  
Common Hepatic Duct ◽  
Rare Entity ◽  
Case Presentation ◽  
Complete Obstruction ◽  
The Common

Background: Congenital biliary web of the extra-hepatic biliary tree is becoming exceedingly rare cause of obstructive jaundice in children. Case Presentation: We report a case of 5-month-old male baby who presented with acholic stools and persistent jaundice since birth. Magnetic resonance cholangiopancreatography (MRCP) showed contracted gall bladder and focal narrowing at mid portion of the common bile duct (CBD) with proximal dilatation of biliary channels. On exploration, a complete web was found just proximal to the confluence of cystic duct and common hepatic duct causing complete obstruction of biliary tree. A Roux-en-Y hepatico-jejunostomy was done. Postoperative recovery was uneventful. Conclusion: We conclude that congenital biliary web is a rare entity and should be considered in the dif­ferential diagnosis of biliary atresia.

scholarly journals Surgical approach to a left-sided gallbladder

2019 ◽  
Vol 12 (8) ◽  
pp. e230681
Author(s):  
Ryan Pereira ◽  
Marlon Perera ◽  
Matthew Roberts ◽  
John Avramovic
Keyword(s):  
Cystic Duct ◽  
Imaging Modality ◽  
Hepatic Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Falciform Ligament ◽  
Biliary Colic ◽  
Common Hepatic Duct ◽  
Critical View Of Safety ◽  
Symptomatic Gallstones ◽  
The Right

Biliary colic is a pain in the right upper quadrant or epigastrium thought to be caused by functional gallbladder spasm from a temporary obstructing stone in the gallbladder neck, cystic duct or common bile duct. A 56-year-old man presented with frequent episodes of typical biliary colic. At initial laparoscopy, the gallbladder was absent from its anatomic location. Further inspection revealed a left-sided gallbladder (LSGB), suspended from liver segment 3. Preoperative ultrasound, the most common imaging modality for symptomatic gallstones, has a low positive predictive value for detecting LSGB (2.7%). Laparoscopic cholecystectomy (LC) was delayed to attain additional imaging. A magnetic resonance cholangiopancreatography demonstrated the gallbladder left of the falciform ligament with the cystic duct entering the common hepatic duct from the left. The patient underwent an elective LC 8 weeks later. The critical view of safety is paramount to safe surgical dissection and could be safely achieved for LSGB.

scholarly journals Anatomical Variations of Cystic Ducts in Magnetic Resonance Cholangiopancreatography and Clinical Implications

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Radha Sarawagi ◽  
Shyam Sundar ◽  
Sanjeev K. Gupta ◽  
Sameer Raghuwanshi
Keyword(s):  
Magnetic Resonance ◽  
Cystic Duct ◽  
Imaging Modality ◽  
Hepatic Duct ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Anatomical Variations ◽  
Common Hepatic Duct ◽  
Clinical Implications ◽  
Imaging Features ◽  
Type Iv

Background. Anatomical variations of cystic duct (CD) are frequently unrecognized. It is important to be aware of these variations prior to any surgical, percutaneous, or endoscopic intervention procedures.Objectives. The purpose of our study was to demonstrate the imaging features of CD and its variants using magnetic resonance cholangiopancreatography (MRCP) and document their prevalence in our population.Materials and Methods. This study included 198 patients who underwent MRCP due to different indications. Images were evaluated in picture archiving communication system (PACS) and variations of CD were documented.Results. Normal lateral insertion of CD at middle third of common hepatic duct was seen in 51% of cases. Medial insertion was seen in 16% of cases, of which 4% were low medial insertions. Low insertion of CD was noted in 9% of cases. Parallel course of CD was present in 7.5% of cases. High insertion was noted in 6% and short CD in 1% of cases. In 1 case, CD was draining into right hepatic duct. Congenital cystic dilation of CD was noted in one case with evidence of type IV choledochal cyst.Conclusion. Cystic duct variations are common and MRCP is an optimal imaging modality for demonstration of cystic duct anatomy.

scholarly journals Mirizzi Syndrome with Cholecystobiliary Fistula: Observation of Development from Asymptomatic Cholecystolithiasis to Surgery

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Hiroyuki Sugo ◽  
Yuuki Sekine ◽  
Naoki Iwanaga ◽  
Shigefumi Neshime ◽  
Michio Machida
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Hepatic Duct ◽  
Filling Defect ◽  
Mirizzi Syndrome ◽  
Common Hepatic Duct ◽  
Gallbladder Stone ◽  
Quadrant Pain ◽  
Abdominal Ct ◽  
The Common

Despite a considerable number of reports of Mirizzi syndrome, none have described the process of its development from simple cholecystolithiasis. We report an extremely rare case of Mirizzi syndrome in which it was possible to observe the process of development of cholecystobiliary fistula from asymptomatic cholecystolithiasis until unavoidable surgical intervention 4 years later. A 68-year-old woman presented at our hospital with right upper quadrant pain. She had been diagnosed as having asymptomatic cholecystolithiasis 4 years previously. Diagnostic abdominal computed tomography (CT) had revealed a 1.9 cm radiopaque stone, and thereafter, the patient had been monitored by imaging alone. CT conducted 6 months before the present admission revealed that the gallbladder stone was compressing the common hepatic duct, although the patient remained asymptomatic. On admission, abdominal CT showed that the gallbladder stone was obstructing the common bile duct with dilatation of the intrahepatic duct. Endoscopic retrograde cholangiopancreatography revealed a round filling defect at the confluence of the common bile duct and the image of the cystic duct; therefore, the patient was categorized as having Mirizzi syndrome type III, according to the Csendes classification. Intraoperative findings revealed a cholecystobiliary fistula involving up to two-thirds of the circumference of the common bile duct.

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