Mirizzi's Syndrome: Retrospective Analysis of 17 Cases

Abstract

Mirizzi's syndrome is a rare complication of cholelithiasis and consists of obstruction of the common hepatic duct due to a stone impacted in the cystic duct or gallbladder 2095 patients evaluated by endoscopic retrograde cholangiopancreatography (ERCP) in Tainan Municipal Hospital over the last 5 years yielded 17 cases (0.8%) suffering from Mirizzi's syndrome. 15 patients underwent surgical intervention. Their endoscopic retrograde cholangiograms, clinical features and outcome were reviewed. Seventeen patients had a cholangiographic diagnosis of Mirizzi's syndrome type I (McSherry's classification). Of these, 5 patients had a low cystic duct insertion with the common hepatic duct. The mean age was 58.1 years (range 36-98); 4 were females. 15 patients were referred for surgery and 9 of these patients had preliminary drainage. The detection rate of Mirizzi's syndrome was 12% in ultrasonography and 14% in computed tomography respectively. One patient received long term stenting, while extraction of the cystic duct stone was performed in the rest of the patients using a combination of percutaneous transhepatic cholangioscopic surgery and endoscopic therapy. Complications occurred in 2 of 17 cases after ERCE Preoperative diagnosis of Mirizzi's syndrome is important to plan a surgical strategy and to avoid complication. ERCP allows diagnosis and classifications of Mirizzi's syndrome; therapeutic endoscopy provides temporary biliary drainage and stones extraction in poor surgical risk candidates.