Mirizzi syndrome in a native American population

Abstract

Mirizzi syndrome is a rare disorder consisting of obstruction of the common hepatic duct resulting from gallstone impaction in the cystic duct or neck of the gallbladder. Formation of a biliobiliary fistula is common, and if unrecognized at the time of surgery, may result in major biliary ductal injury. The severity of biliary tract disease among Native Americans led to this retrospective review of Mirizzi syndrome to determine complications and intraoperative management. A review of 623 biliary tract operations performed from October 1990 to December 1992 identified 17 patients (2.7%) with the disorder, representing a greater incidence than in non-Native American populations. Five patients had type I Mirizzi syndrome with either a parallel cystic duct (2 patients) or an obliterated duct (3 patients). Twelve patients had type II Mirizzi syndrome with a biliobiliary fistula. Cholangiograms were obtained in 12 cases. Seven fistulas were closed primarily and 4 were closed over catheters. There were no deaths, and 4 major complications occurred, including 1 bile-duct injury. A follow-up period of 1 to 3.5 years (mean 2.5) revealed no long-term problems. Mirizzi syndrome among the Native American population can be managed successfully by appropriate diagnostic and surgical techniques.