RÉSUMÉ
Mirizzi syndrome is a serious complication of gallstone disease. It is caused by the impacted stones in the gallbladder neck or cystic duct. One of the features of Mirizzi syndrome is severe inflammation or dense fibrosis at the Calot's triangle. In our clinical practice, bile duct, branches of right hepatic artery and right portal vein clinging to gallbladder infundibulum are often observed due to gallbladder infundibulum adhered to right hepatic hilum. The intraoperative damage of branches of right hepatic artery occurs more easily than that of bile duct, all of which are hidden pitfalls for surgeons. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) are the preferable tools for the diagnosis of Mirizzi syndrome. Anterograde cholecystectomy in Mirizzi syndrome is easy to damage branches of right hepatic artery and bile duct due to gallbladder infundibulum adhered to right hepatic hilum. Subtotal cholecystectomy is an easy, safe and definitive approach to Mirizzi syndrome. When combined with the application of ERCP, a laparoscopic management of Mirizzi syndrome by well-trained surgeons is feasible and safe. The objective of this review was to highlight its existing problems: (1) low preoperative diagnostic rate, (2) easy to damage bile duct and branches of right hepatic artery, and (3) high concomitant gallbladder carcinoma. Meanwhile, the review aimed to discuss the possible therapeutic strategies: (1) to enhance its preoperative recognition by imaging findings, and (2) to avoid potential pitfalls during surgery.
Sujet(s)
Lithiase biliaire , Syndrome de Mirizzi , Humains , Syndrome de Mirizzi/imagerie diagnostique , Syndrome de Mirizzi/chirurgie , Cholangiopancréatographie rétrograde endoscopique , Lithiase biliaire/chirurgie , Cholécystectomie , Conduits biliairesRÉSUMÉ
Hemobilia is an uncommon diagnosis and is often not suspected in the absence of recent hepatobiliary intervention or trauma. Hemobilia in the setting of cystic artery pseudoaneurysm secondary to type I Mirizzi syndrome is a rare occurrence. We report the case of a 61-year-old male who presented with epigastric pain and vomiting. Blood tests demonstrated hyperbilirubinemia with elevated inflammatory markers. Magnetic resonance cholangiopancreatography revealed type I Mirizzi syndrome in the presence of a 21 mm cystic duct stone. During endoscopic retrograde cholangiopancreatography, hemobilia was identified. Subsequent triple phase computed tomography imaging identified a 12 mm cystic artery pseudoaneurysm. Angiography with successful coiling of the cystic artery was accomplished. Cholecystectomy was performed, confirming type I Mirizzi syndrome. This case demonstrates the importance of considering ruptured pseudoaneurysm in patients presenting with evidence of upper gastrointestinal bleeding in the setting of biliary stone disease. Transarterial embolization, followed by surgical management, is effective in both the diagnosis and management of ruptured cystic artery pseudoaneurysm with associated hemobilia.
Sujet(s)
Faux anévrisme , Maladies de la vésicule biliaire , Hémobilie , Syndrome de Mirizzi , Mâle , Humains , Adulte d'âge moyen , Faux anévrisme/complications , Faux anévrisme/imagerie diagnostique , Hémobilie/complications , Syndrome de Mirizzi/complications , Syndrome de Mirizzi/imagerie diagnostique , Syndrome de Mirizzi/chirurgie , Maladies de la vésicule biliaire/complications , Artère hépatique/imagerie diagnostiqueRÉSUMÉ
BACKGROUND: Mirizzi syndrome is a gallstone disease characterized by compression of extrahepatic biliary duct with an impacted stone. Our aim is to identify and describe the incidence, clinical presentation, operative details and the association postoperative complication of Mirizzi syndrome in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). METHODS: The ERCP procedures were held in Gastroenterology Endoscopy Unit and retrospectively evaluated. The patients were divided into two groups, the cholelithiasis + common bile duct (CBD) stone group and the Mirizzi syndrome group. These groups were compared with the demographic characteristics, ERCP procedures, types of Mirizzi syndrome and surgical technique. RESULTS: A total of 1018 consecutive patients who underwent ERCP were scanned retrospectively. Of the 515 patients fulfilling the criteria for ERCP, 12 had Mirizzi syndrome and 503 had cholelithiasis and CBD stones. Half of the Mirizzi syndrome patients were diagnosed with pre-ERCP ultrasonography. The mean diameter of choledoc was found to be 10 mm in ERCP. ERCP-related complication rates (pancreatitis, bleeding and perforation) were the same in the two groups; 66.6% of the Mirizzi syndrome patients applied cholecystectomy and placement of T-tube surgical procedures, and there were no postoperative complications. CONCLUSION: Surgery is the definitive treatment of Mirizzi syndrome. Thus patients should have a correct preoperative diagnosis for an appropriate and safe surgery. We think that ERCP could be the best guide for this. Also, we believe that intraoperative cholangiography with ERCP and hybrid procedures for guiding surgical treatment may become an advanced treatment option in the future.
Sujet(s)
Cholécystectomie laparoscopique , Calculs biliaires , Syndrome de Mirizzi , Humains , Cholangiopancréatographie rétrograde endoscopique/effets indésirables , Cholangiopancréatographie rétrograde endoscopique/méthodes , Études rétrospectives , Syndrome de Mirizzi/imagerie diagnostique , Syndrome de Mirizzi/chirurgie , Calculs biliaires/chirurgie , Complications postopératoires/épidémiologie , Complications postopératoires/étiologieRÉSUMÉ
PURPOSE: Mirizzi Syndrome is a rare disease that causes biliary obstruction in the setting of an impacted stone in the gallbladder neck or Hartmann's Pouch which exerts mass effect on the common duct; however, we have noticed inflammatory biliary narrowing in the absence of an offending gallstone in the setting of acute cholecystitis. The purpose of this study is to report the clinical and MRCP findings in a series of 10 patients with this variant of Mirizzi Syndrome. MATERIALS AND METHODS: A search of our institution's PACS and electronic medical record identified 10 patients with a diagnosis of acute cholecystitis and narrowing of the common duct on imaging in the absence of an impacted gallstone. Imaging and clinical findings were confirmed by two board-certified abdominal radiologists. RESULTS: All patients presented with abdominal pain and an average elevated total bilirubin of 3.0 mg/dL. Seven patients had MRCP findings of complete narrowing of the CBD. Nine patients had intrahepatic biliary ductal dilation. All nine patients with gadoliniumenhanced MRCP displayed biliary wall thickening with enhancement adjacent to the gallbladder. Nine patients underwent cholecystectomy, one patient underwent percutaneous cholecystostomy. Average bilirubin upon discharge was within normal limits at 0.9 mg/dL after intervention. Two patients had follow-up MRCP showing resolution of biliary narrowing. CONCLUSION: A variant of Mirizzi Syndrome occurs in the absence of an offending gallstone in the gallbladder neck or cystic duct to explain the biliary narrowing. We postulate that acute cholecystitis can cause a local inflammatory narrowing resulting in biliary obstruction.
Sujet(s)
Cholécystite aigüe , Cholestase , Calculs biliaires , Syndrome de Mirizzi , Humains , Syndrome de Mirizzi/imagerie diagnostique , Syndrome de Mirizzi/chirurgie , Cholestase/diagnostic , CholécystectomieSujet(s)
Humains , Femelle , Adulte , Cholangiopancréatographie rétrograde endoscopique , Cholécystectomie , Lithiase vésiculaire/chirurgie , Lithiase biliaire/complications , Lithiase biliaire/imagerie diagnostique , Lithiase biliaire/chirurgie , Syndrome post-cholécystectomie/imagerie diagnostique , Syndrome post-cholécystectomie/étiologie , Syndrome post-cholécystectomie/chirurgie , Syndrome de Mirizzi/imagerie diagnostique , Syndrome de Mirizzi/chirurgie , Conduit cystique/imagerie diagnostique , Conduit cystique/chirurgieSujet(s)
Syndrome de Mirizzi , Maladies du pancréas , Anomalie de jonction biliopancréatique , Humains , Syndrome de Mirizzi/imagerie diagnostique , Syndrome de Mirizzi/étiologie , Conduits pancréatiques/imagerie diagnostique , Conduits pancréatiques/malformations , Maladies du pancréas/diagnostic , Maladies du pancréas/imagerie diagnostiqueRÉSUMÉ
Mirizzi syndrome is a rare type of cholelithiasis, and the main treatment is still surgery. The development of endoscopic technology has made surgeons more active in the management of rare diseases of the biliary tract and pancreas. Here we report that our center applied the new endoscopic method to treat a Mirizzi patient with residual cystic neck duct stones after laparoscopic cholecystectomy.
Sujet(s)
Cholécystectomie laparoscopique , Lithiase vésiculaire , Lithiase biliaire , Syndrome de Mirizzi , Syndrome post-cholécystectomie , Cholangiopancréatographie rétrograde endoscopique , Lithiase vésiculaire/chirurgie , Lithiase biliaire/complications , Lithiase biliaire/imagerie diagnostique , Lithiase biliaire/chirurgie , Conduit cystique/imagerie diagnostique , Conduit cystique/chirurgie , Humains , Syndrome de Mirizzi/imagerie diagnostique , Syndrome de Mirizzi/chirurgie , Syndrome post-cholécystectomie/imagerie diagnostique , Syndrome post-cholécystectomie/étiologie , Syndrome post-cholécystectomie/chirurgieRÉSUMÉ
BACKGROUND: Laparoscopic cholecystectomy (LC) with associated procedures and endoscopic retrograde cholangiopancreatography (ERCP) have been the standard treatments for both common and rare biliary diseases. Mirizzi syndrome (MS) is a rare and complex biliary condition. We report our experience with MS treatment and investigate the value of laparoscopic procedures and ERCP in patient management. METHODS: From 2004 to 2017, 100 consecutive patients with MS were diagnosed by ERCP and underwent surgery in a referral center. Sixty patients were treated with intended LC, and 40 patients were treated with open cholecystectomy (OC). The clinical manifestations, ERCP and associated procedures, surgical procedures, and postoperative outcomes were investigated. RESULTS: The surgical mortality rate was 1%, while the surgical morbidity rate was 15%. The patients treated with intended LC suffered from less morbidity (5%). The percentage of postoperative residual biliary stones was 32% (n = 32), and only three patients underwent re-operation (laparotomy) for stone removal. The laparotomy conversion rate in the intended LC group was 16.7% (10/60). The length of hospitalization for the patients with successful LC was significantly shorter than that for the patients with conversion and intended OC. Csendes classification was a risk factor for conversion from LC to OC (type I vs types II to V, P < .0001). CONCLUSIONS: A combination of a laparoscopic procedure and ERCP may provide therapeutic benefits for patients with MS.
Sujet(s)
Cholécystectomie laparoscopique , Laparoscopie , Syndrome de Mirizzi , Cholangiopancréatographie rétrograde endoscopique , Cholécystectomie laparoscopique/effets indésirables , Humains , Syndrome de Mirizzi/imagerie diagnostique , Syndrome de Mirizzi/chirurgie , Résultat thérapeutiqueSujet(s)
Tumeurs des canaux biliaires , Cholangiocarcinome , Syndrome de Mirizzi , Tumeurs des canaux biliaires/imagerie diagnostique , Conduits biliaires intrahépatiques , Cholangiocarcinome/imagerie diagnostique , Cholangiopancréatographie rétrograde endoscopique , Humains , Syndrome de Mirizzi/imagerie diagnostique , Syndrome de Mirizzi/étiologieSujet(s)
Tumeurs des canaux biliaires , Procédures de chirurgie des voies biliaires , Syndrome de Mirizzi , Tumeurs des canaux biliaires/complications , Tumeurs des canaux biliaires/imagerie diagnostique , Tumeurs des canaux biliaires/chirurgie , Conduits biliaires intrahépatiques , Humains , Syndrome de Mirizzi/imagerie diagnostiqueRÉSUMÉ
BACKGROUND: Mirizzi syndrome (MS) is defined as an extrinsic compression of the extrahepatic biliary system by an impacted stone in the gallbladder or the cystic duct leading to obstructive jaundice. Endoscopic retrograde cholangiopancreatography (ERCP) could serve diagnostic and therapeutic purposes in patients with MS in addition to revealing the relationships between the cystic duct, the gallbladder, and the common bile duct (CBD). Cholecystectomy is a challenging procedure for a laparoscopic surgeon in patients with MS, and the presence of a cholecystocholedochal fistula renders preoperative diagnosis important during ERCP. AIM: To evaluate cholecystocholedochal fistulas in patients with MS during ERCP before cholecystectomy. METHODS: From 2004 to 2018, all patients diagnosed with MS during ERCP were enrolled in this study. Patients with associated malignancy or those who had already undergone cholecystectomy before ERCP were excluded. In total, 117 patients with MS diagnosed by ERCP were enrolled in this study. Among them, 21 patients with MS had cholecystocholedochal fistulas. MS was further confirmed during cholecystectomy to check if cholecystocholedochal fistulas were present. The clinical data, cholangiography, and endoscopic findings during ERCP were recorded and analyzed. RESULTS: Gallbladder opacification on cholangiography is more frequent in patients with MS complicated by cholecystocholedochal fistulas (P < 0.001). Pus in the CBD and stricture length of the CBD longer than 2 cm were two additional independent factors associated with MS, as demonstrated by multivariate analysis (odds ratio 5.82, P = 0.002; 0.12, P = 0.008, respectively). CONCLUSION: Gall bladder opacification is commonly seen in patients with MS with cholecystocholedochal fistulas during pre-operative ERCP. Additional findings such as pus in the CBD and stricture length of the CBD longer than 2 cm may aid the diagnosis of MS with cholecystocholedochal fistulas.
Sujet(s)
Cholécystectomie laparoscopique , Fistule , Syndrome de Mirizzi , Cholangiopancréatographie rétrograde endoscopique , Cholécystectomie , Conduit cholédoque , Humains , Syndrome de Mirizzi/imagerie diagnostique , Syndrome de Mirizzi/chirurgieRÉSUMÉ
Postcholecystectomy Mirizzi syndrome (PCMS) is an uncommon entity that can occur due to cystic duct stump calculus, gall bladder remnant calculus or migrated surgical clip. It can be classified into early PCMS or late PCMS. It is often misdiagnosed and the management depends on the site of impaction of stone or clip. Endoscopy can be performed for cystic duct stump calculus. However, surgery is the treatment for remnant gall bladder calculus. Role of laparoscopic management is controversial. We present here a case of a 48-year-old woman with late PCMS due to an impacted calculus in a sessile gall bladder remnant following a subtotal cholecystectomy, managed with laparoscopic completion cholecystectomy, review the literature, provide tips for safe laparoscopy for PCMS and summarise our algorithmic approach to the management of the postcholecystectomy syndrome.
Sujet(s)
Cholécystectomie laparoscopique/méthodes , Syndrome de Mirizzi/chirurgie , Syndrome post-cholécystectomie/chirurgie , Calculs/imagerie diagnostique , Calculs/chirurgie , Femelle , Humains , Imagerie par résonance magnétique , Adulte d'âge moyen , Syndrome de Mirizzi/complications , Syndrome de Mirizzi/imagerie diagnostique , Syndrome post-cholécystectomie/étiologie , RéinterventionRÉSUMÉ
A 64-year-old female presented to the Emergency Department with jaundice, choluria, fever and abdominal pain over the last few days. The abdomen was tender with epigastric pain on palpation.
Sujet(s)
Maladies des canaux biliaires/imagerie diagnostique , Conduits biliaires intrahépatiques , Calculs biliaires/imagerie diagnostique , Syndrome de Mirizzi/imagerie diagnostique , Maladies des canaux biliaires/complications , Dilatation pathologique , Femelle , Calculs biliaires/complications , Humains , Adulte d'âge moyen , Syndrome de Mirizzi/complicationsRÉSUMÉ
No disponible
Sujet(s)
Humains , Femelle , Adulte d'âge moyen , Cholangiopancréatographie rétrograde endoscopique/méthodes , Syndrome de Mirizzi/imagerie diagnostique , Lithiase biliaire/imagerie diagnostique , Traitement d'urgence , Ictère/étiologie , Douleur abdominale/étiologie , Conduits biliaires intrahépatiques/imagerie diagnostiqueRÉSUMÉ
INTRODUCTION: A 50-year-old Japanese man presented with obstructive jaundice. We performed endoscopic retrograde biliary drainage before biliary decompression. CT showed a thickened gallbladder wall with low-density areas and a 35-mm gallstone; the stone was impacted in the gallbladder neck and cystic duct. The patient was therefore diagnosed with Mirizzi syndrome (type II or III) and scheduled for laparoscopic treatment. We performed subtotal cholecystectomy and intraoperative choledochoscopy because we recognized a fistula between the gallbladder and common bile duct preoperatively. MATERIALS AND SURGICAL TECHNIQUE: We opened the ductus choledochus, and a choledochoscope was introduced under laparoscopic guidance. An electrohydraulic lithotripsy probe with irrigation was passed through the choledochoscope to extract the gallstone. DISCUSSION: This fragmentation technique is effective for impacted large stones observed in Mirizzi syndrome. Therefore, electrohydraulic lithotripsy with laparoscopy is effective in cases of difficult gallbladder access such as that that occurs in type II or III Mirizzi syndrome.
Sujet(s)
Laparoscopie/méthodes , Lithotritie/méthodes , Syndrome de Mirizzi/thérapie , Association thérapeutique , Humains , Mâle , Adulte d'âge moyen , Syndrome de Mirizzi/imagerie diagnostique , TomodensitométrieRÉSUMÉ
No disponible