RESUMO
Mirizzi syndrome, known as extrinsic bile compression syndrome, is a rare complication of cholecystitis and chronic cholelithiasis, secondary to the obliteration of the infundibulum of the gallbladder or cystic duct caused by the impact of one or more calculations in these anatomical structures, which leads to compression of the adjacent bile duct, resulting in partial or complete obstruction of the common hepatic duct, triggering liver dysfunction. Our aim is to identify and describe the current epidemiology, diagnostic methods, and treatment of Mirizzi syndrome. A literature search was performed using different databases, including Medline, Cochrane, Embase, Medscape, PubMed, using keywords: Mirizzi syndrome, epidemiology, markers, pathophysiology, clinical presentation, diagnosis, and treatment. Selected original articles, review articles or case reports from 1997 to 2015 were collected, written in English or Spanish. The endoscopic retrograde cholangiopancreatography (ERCP) is the most accurate diagnostic method. The traditional treatment has been surgery and involves an incision at the bottom of the gallbladder and calculus removal. If fistulas are observed, it is performed a partial cholecystectomy; otherwise, a cholecystocholedochoduodenostomy is an alternative. Endoscopic treatment includes biliary drainage and stone extraction. Many surgeons claim that laparoscopic cholecystectomy is contraindicated in Mirizzi syndrome because of the presence of inflammatory tissue and adhesions in the Calot's triangle. If dissection is attempt, it can cause unnecessary injury to the bile duct. However, other surgeons consider the laparoscopic approach is feasible, although technically challenging. Currently, laparoscopic cholecystectomy for this condition is considered controversial and technically challenging; however, it has shown that with the right skills and equipment, it is a safe and feasible way to treat some cases of Mirizzi syndrome type I and II.
RESUMO
Resumen El hipertiroidismo es una patología frecuente que suele ser fácilmente reconocida por sus síntomas y signos. El hipertiroidismo apático es una forma de presentación de hipertiroidismo sin signos y síntomas característicos. Los síntomas cardinales del hipertiroidismo apático son la depresión y apatía; por ello, la ausencia de síntomas y signos clásicos retrasa el diagnóstico y el tratamiento, pues a menudo se diagnostica erróneamente como un trastorno psiquiátrico primario. Es más frecuente en pacientes de edad avanzada y es extremadamente rara en niños y adultos de mediana edad. Reportamos el caso de una mujer de mediana edad con hipertiroidismo apático caracterizado por depresión, vértigo, edema y pérdida de peso, sin otros datos clínicos de hipertiroidismo. Durante dos años recibió tratamiento por depresión, y adicionalmente fue estudiada en otras especialidades por vértigo. El diagnóstico se estableció mediante pruebas de función tiroidea y la integración con las características clínicas.
Abstract Hyperthyroidism is a common condition that is easily recognized by its signs and symptoms. The apathetic hyperthyroidism is a form of presentation of hyperthyroidism without its characteristic signs and symptoms. The cardinal symptoms of apathetic hyperthyroidism are depression and apathy. The absence of classical signs and symptoms of hyperthyroidism delays the diagnosis and treatment of the disease, as it is often misdiagnosed as a primary psychiatric disorder. It is more common in elderly patients and is extremely rare in children and middle-age adults. We report the case of a middle-age woman with apathetic hyperthyroidism characterized by depression, dizziness, edema and weight loss without other clinical data of hyperthyroidism; she had been treated for two years for major depressive disorder. She had been studied by other specialties because of vertigo. The diagnosis was made after thyroid function tests were requested, and joined with clinical findings.
