Mirizzi Syndrome Type Research Articles

Endoscopic Retrograde Cholangiopancreatography (ERCP) for Suspected Mirizzi Syndrome Type IV as Both a Diagnostic and Bridge-to-Surgery Procedure.

Mirizzi syndrome (MS) is a challenging diagnosis due to its similar presentation with other biliary diseases; thus, the role of endoscopy is sometimes unclear, especially in altered anatomy. Radiological examinations may usually suspect it, but deeper examinations could be necessary to confirm it. Endoscopic retrograde cholangiopancreatography (ERCP) certainly has a therapeutic role in cases of jaundice, cholangitis or concurrent choledocolithiasis, although surgery is without doubt the definitive treatment in most of the cases. Therefore, surgeons may have a clearer picture of the condition of the biliary tree with respect to fistulas thanks to ERCP, particularly in patients with a higher grade of MS (type higher than 2 in the Csendes classification). Therefore, a complete removal of biliary stones is sometimes not possible due to size and location, so biliary stenting becomes the only option, even if transitory. Our brief report is a further demonstration of the fundamental role of ERCP in managing MS, even when it has no long-term therapeutic aim but is performed as bridge-to-surgery, especially in cases with a more difficult biliary anatomy due to the type of fistula. Moreover, we truly suggest discussing patients affected with MS in a multidisciplinary board, preferably in tertiary hepatobiliary centers.

Mirizzi Syndrome Secondary to Impacted Stone in A Low Inserted Cystic Duct Variant: Case Report

Abstract Introduction. Cystic duct anatomical variations are encountered frequently during surgical procedures. In this report, a female patient underwent laparoscopic cholecystectomy for acute cholecystitis and developed symptoms of obstructive jaundice subsequently, which was diagnosed as low insertion of the cystic duct and an impacted stone that was causing common hepatic duct obstruction. Case report. A 42-year-old female presented to the emergency room complaining of persistent right upper quadrant pain that was radiating to the back. White blood count (WBC) was slightly elevated with normal liver function tests (LFTs). An abdominal ultrasound was performed and confirmed cholelithiasis with no signs of acute cholecystitis or biliary dilatation. The patient underwent laparoscopic cholecystectomy as an emergency procedure for persistent biliary colic. Eight days later, the patient returned to the emergency room with obstructive jaundice and continued right upper quadrant pain with elevated WBC and LFTs. Further tests were conducted, and the patient was found to have a long cystic duct with a low insertion variant to the common hepatic duct. An impacted stone was identified in the cystic duct, referred to as Mirizzi syndrome Type I. The patient underwent endoscopic retrograde cholangiopancreatography (ERCP) several times, but the common bile duct could not be cannulated. In the last ERCP session, SpyGlass and electrohydraulic lithotripsy were performed with a balloon sweep. Conclusion. This case demonstrates the importance of understanding Mirizzi syndrome and cystic duct variation to achieve optimal treatment, and careful assessment and investigation are essential for proper diagnosis. In experienced hands, Mirizzi syndrome secondary to an impacted cystic duct stone can be managed successfully with ERCP, electrohydraulic lithotripsy, and SpyGlass.

A rare gastrointestinal bleeding due to a cholecystoduodenal fistula: a case report

BackgroundGastrointestinal bleeding from cholecystoduodenal fistula is rare. It is usually managed surgically, although a conservative approach is reported in isolated cases.Case presentationA 71-year-old male patient was admitted to the emergency department (ED) presenting melena associated with severe anemia, requiring a blood transfusion. An urgent upper endoscopy showed the intestinal orifice of a cholecystoduodenal fistula. This finding was confirmed by radiological examination and laparoscopy. Cholecystectomy and simultaneous excision of the fistula were successfully performed. As a result, a diagnosis of Mirizzi syndrome type Va was also made.ConclusionA cholecystoduodenal fistula orifice leading to gastrointestinal bleeding is difficult to diagnose without an endoscopic examination of the upper digestive tract. Following this first diagnostic step, a comprehensive patient examination should be conducted, specifically if a history of gallbladder lithiasis has been reported.

Mirizzi syndrome type V complicated with triple fistula: a case report

BackgroundMirizzi syndrome (MS) is a complicated form of longstanding, symptomatic cholelithiasis. According to Beltran Classification MS Type V has been introduced to describe the cholecystoenteric fistula, with or without gallstone ileus. Mirizzi syndrome Type V with double fistula has been reported in the past; however, the triple fistula is an even rarer case, first described in the international literature so far.Case presentationA 77-year-old male was admitted to our surgical department with recurrent episodes of abdominal pain, which initially presented in the last 6 months and was accompanied with jaundice. Computed tomography showed findings of cholelithiasis, pneumobilia and choledocholithiasis. We performed an ERCP, which showed two fistulas of the gallbladder with the pyloric antrum and the duodenum, respectively. Surgical treatment was immediately undergone and during laparotomy, we confirmed these findings. We ligated and dissected these communications. In addition, a third fistula between the gallbladder and the common bile duct was identified. An insertion of a Kehr T-tube into the common bile duct was performed via the gallbladder. After 3 months, the Kehr T-tube was removed and in the subsequent 2 years of follow-up the patient was presented without complications.ConclusionsMirizzi syndrome complicated with triple fistula, first described in the international literature, to the best of our knowledge, confirms the long natural history of inflammation.

Exploring the imaging features and treatment options of Mirizzi syndrome

The patient is a 54-year-old female who presented to the emergency department for episodic right biliary colic with nausea and vomiting over the past year. The patient's symptoms warranted multiple emergency department visits, but were self-limiting. During the most recent visit, the patient had a low-grade fever of 99.8°F (96.8°F-99.5°F) and a borderline elevated total bilirubin of 1.2 (0.2-1.2 mg/dL). Abdominal ultrasound revealed cholelithiasis, gallbladder wall thickening, and biliary ductal dilatation. Subsequent MRCP revealed an impacted stone within the gallbladder neck and a prominent common hepatic duct, compatible with Mirizzi syndrome Type I. The obtained imaging combined with clinical correlation in the setting of jaundice and right upper quadrant pain guided the patient's management. A laparoscopic cholecystectomy was performed and the patient was safely discharged the following day.

Staged treatment of the Mirizzi syndrome Type 4, complicated by obstructive jaundice and acute cholangitis, in the COVID-19 pandemic

Staged treatment of the Mirizzi syndrome Type 4, complicated by obstructive jaundice and acute cholangitis, in the COVID-19 pandemic

Laparoscopic subtotal reconstituting cholecystectomy in type II & III Mirizzi syndrome: Case series of 5 patients.

BackgroundMirizzi syndrome Type II & III treatment is a true surgical challenge. The purpose was to determine whether the laparoscopic subtotal reconstituting cholecystectomy can be a safe and effective approach in our institution to treat Mirizzi Syndrome type II and III.Case presentationWe report a case series of 5 patients with Mirizzi syndrome type II and III who underwent laparoscopic subtotal reconstituting cholecystectomy.DiscussionWe found only one patient had presurgical diagnosis, average surgical time of 218 min, average surgical bleeding of 230 ml and the mean hospital stay of 3.4 days; one patient presented low volume and auto limited biliary leak; no cases presented biliary injury, major complications, or reintervention.ConclusionsLaparoscopic subtotal reconstituting cholecystectomy is a security and effective technique to treat type II and III Mirizzi syndrome in our context.

Surgical strategies for Mirizzi syndrome: A ten-year single center experience.

BACKGROUNDMirizzi syndrome (MS) remains a challenging biliary disease, and its low rate of preoperative diagnosis should be resolved. Moreover, technological advances have not resulted in decisive improvements in the surgical treatment of MS. Complex bile duct lesions due to MS make surgery difficult, especially when the laparoscopic approach is adopted. The safety and long-term effect of MS treatment need to be guaranteed in terms of preoperative diagnosis and surgical strategy.AIMTo analyze preoperative diagnostic methods and the safety, effectiveness, prognosis and related factors of surgical strategies for different types of MS.METHODSThe clinical data of MS patients who received surgical treatment from January 1, 2010 to December 31, 2020 were retrospectively reviewed. Patients with malignancies, choledochojejunal fistula, lack of data and lost to follow-up were excluded. According to preoperative imaging examination records and documented intraoperative findings, the clinical types of MS were determined using the Csendes classification. The safety, effectiveness and long-term prognosis of surgical treatment in different types of MS, and their interactions with the clinical characteristics of patients were summarized.RESULTSSixty-six patients with MS were included (34 males and 32 females). Magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP) showed specific imaging features of MS in 58 cases (87.9%), which was superior to ultrasound scan (USS) in the diagnosis of MS and more sensitive to subtle biliary lesions than USS. The overall laparoscopic surgery completion rate was 53.03% (35/66), where the completion rates of MS type I, II and III were 69.05% (29/42), 42.86% (6/14) and zero (0/10), respectively. Thirty-one patients (46.97%) underwent laparotomy or conversion to laparotomy including 11 cases of iatrogenic bile duct injury which occurred in type I patients, and 25 of these patients underwent bile duct exploration, repair and T-tube drainage. In addition, 25 patients underwent intraoperative choledochoscopy and T-tube cholangiography. Overall, 21 cases (31.8%) were repaired by simple suturing, and 14 cases (21.2%) were repaired using the remaining gallbladder wall patch in the subtotal cholecystectomy. The ascendant of the Csendes classification types led to an increase in surgical complexity reflected by increased operation time, bleeding volume and cost. Gender, acute abdominal pain and measurable stone size had no effect on Csendes type of MS or final surgical approach. Age had no effect on the classification of MS, but it influenced the final surgical approach, hospital stay and cost. A total of 66 patients obtained a relatively high preoperative diagnostic rate and underwent surgery safely without serious complications, and no mortality was observed during the follow-up period of 36.5 ± 26.5 mo (range 13-76, median 22 mo).CONCLUSIONMRI/MRCP can improve the preoperative diagnosis of MS. The Csendes classification can reflect the difficulty of treatment. The surgical strategies including laparoscopic surgery for MS should be formulated based on full evaluation and selection.

Laparoscopic modified subtotal cholecystectomy is a safe method in the management of mirizzi syndrome type I

Background: Efforts to reveal the cystic duct and the cystic artery during standard cholecystectomy in Mirizzi Syndrome (MS) without preoperative or intraoperative diagnosis increase the risk of biliary and vascular injury due to intense fibrosis in the Calot’s triangle. We aim to evaluate the postoperative results of a group of MS type I patients who were diagnosed by video scope intraoperatively and underwent laparoscopic modified subtotal cholecystectomy (LMSC) in the same session since safe dissection of Calot’s triangle could not be performed. Methods: Ten out of 1680 patients who underwent conventional laparoscopic cholecystectomy for acute or chronic cholecystitis between 2017 and 2019 were diagnosed with MS type I intraoperatively. These 10 patients underwent LMSC and their demographic characteristics, preoperative clinical histories, radiological images, intraoperative and postoperative findings were evaluated retrospectively. Intraoperative MS type determination and LMSC technique are explained. Results: The diagnoses of MS type I in all our cases were made laparoscopically with the help of a videoscope during the operation where safe dissection of the Calot’s triangle could not be performed in either elective or emergency cholecystectomy. LMSC was performed without leaving any cavity behind, and there was no need for any intervention at the operation site (suture, staple closure) since the cystic duct orifice was already obstructed due to fibrosis as visually verified by the camera. There were no intraoperative bile duct injuries or postoperative biliary fistula. None of our patients developed postcholecystectomy syndrome (range 1-38 months) Conclusion: The LMSC is a safe procedure in the diagnosis and surgery of MS type I where safe dissection of Calot’s triangle could not be performed

Robotic Management of Mirizzi Syndrome Type IV with Cholecystocolic Fistula: A Rare Case Report

Introduction: Mirizzi syndrome (MS) is a rare complication of prolonged cholelithiasis, with presence of a large gallstone impacted in Hartmann’s pouch, causing chronic extrinsic compression of the common bile duct, and potentially leading to fistula formation between the gallbladder and the common bile duct and/or bowel. Laparoscopic management is widely accepted for MS type I/II, whereas open surgery is the preferred approach for MS type III/IV and presence of a cholecystoenteric fistula. Robotic surgery has the advantage of 3D visualization and endowrist technology, helping to operate more accurately compared to laparoscopy, and could provide an appropriate alternative surgical approach. This report describes the robotic management of a MS type IV with cholecystocolic fistula. Method: The surgical procedure involved a robotic cholecystectomy with a small wedge excision of segment 4B/5 junction, extrahepatic bile duct resection, evacuation of major choledocholithiasis, and wedge excision of a cholecystocolic fistula at the transverse colon. Biliary enteric anastomosis was realized by Roux-en-Y hepaticojejunostomy. The colon was closed using a Heineke-Mikulicz plasty. Dissection was done by monopolar scissors, fenestrated bipolar forceps and robotic sealing device. Results: Operative time was 240 minutes and blood loss 30 cc. Pathology showed chronic cholecystitis without underlying malignance. No intraoperative complications were encountered and the postoperative course was uneventful. Discharged happened on postoperative day 5. Conclusions: Robotic surgery is a safe and feasible technique for MS type IV with cholecystocolic fistula.

Emergency surgery for hemobilia due to hepatic artery pseudoaneurysm rupture complicated by Mirizzi syndrome type II: a case report

BackgroundHemobilia refers to bleeding into the biliary tract. Hepatic artery pseudoaneurysm (HAP) rupture is an uncommon cause of hemobilia, and cases of HAP associated with Mirizzi syndrome are extremely rare. Although transarterial embolization is recommended as the first-line treatment for hemobilia, surgery is sometimes required.Case presentationA 76-year-old woman was referred to our hospital with epigastric pain. She was febrile and had conjunctival icterus and epigastric tenderness. Laboratory tests revealed abnormal white blood cell count and liver function. An abdominal computed tomography (CT) revealed multiple calculi in the gallbladder, an incarcerated calculus in the cystic duct, and a slightly dilated common hepatic duct. Based on examination findings, she was diagnosed with Mirizzi syndrome type I, complicated by cholangitis. Intravenous antibiotics were administered, and we performed endoscopic retrograde cholangiopancreatography (ERCP) to place a drainage tube. The fever persisted; therefore, contrast-enhanced CT (CECT) was performed. This revealed portal vein thrombosis and hepatic abscesses; therefore, heparin infusion was administered. The following day, she complained of melena, and laboratory tests showed that she was anemic. ERCP was performed to change the drainage tube in the bile duct; however, bleeding from the papilla of Vater was observed. CECT demonstrated a right HAP with high-density fluid in the gallbladder and gallbladder perforation. Finally, she was diagnosed with hemobilia caused by HAP rupture, and emergency surgery was performed to secure hemostasis and control the infection. During laparotomy, we found that a right HAP had ruptured into the gallbladder. The gallbladder made a cholecystobiliary fistula, which indicated Mirizzi syndrome type II. Although we tried to repair the right hepatic artery, we later ligated it due to arterial wall vulnerability. Then, we performed subtotal cholecystectomy and inserted a T-tube into the common bile duct. There were no postoperative complications except for minor leakage from the T-tube insertion site. The patient was discharged after a total hospital stay of 7 weeks.ConclusionsWe experienced an extremely rare case of emergency definitive surgery for hemobilia due to HAP rupture complicated by Mirizzi syndrome type II. Surgery might be indicated when controlling underlying infections was required.

Endoscopic treatment including a single-operator peroral cholangioscopy-guided electrohydraulic lithotripsy and endoscopic nasogallbladder drainage combined laparoscopic cholecystectomy for Mirizzi syndrome

Mirizzi Syndrome (MS) is rare among gallbladder diseases and may be difficult to treat. In particular, endoscopic treatment often fails owing to unable to access or capture the impacted cystic duct stone. We report a case of MS grade III that were successfully managed by an endoscopic treatment and interval laparoscopic cholecystectomy. A 59-year-old women was admitted our hospital presenting with upper abdominal pain and fever up to 38.5℃. She was mildly jaundiced with scleral icterus with a positive Murphy's sign. An abdomen computed tomography scan and T2-weight magnetic resonance cholangiopancreatography image demonstrated about 1.4cm stone at junction of the cystic duct and mid-common bile duct with cholecysto-choledochal fistula, compatible with MS type III and acute calculus cholecystitis. A digital single-operator cholangioscopy (DSOC)-guided eletrohydraulic lithotripsy (EHL) was performed. Elective laparoscopic cholecystectomy was performed after the stones were completely removed. The patient was discharged without any complications on the 5th day after surgery. The treatment of MS is mainly surgical and consists of partial or complete cholecystectomy with or without common bile duct exploration. However, in the era of minimal invasive treatment, laparoscopy treatment for low grade MS is being tried steadily. In our case, through preoperative intervention using DSOC guided EHL, the effect of downgrading MS could be achieved, and this resulted in a safe laparoscopic surgical approach. In conclusion, DSOC guided EHL with ENGBD may allow a minimally invasive approach for management of high grade MS.

Treatment Methods for Different Variations Syndrome Mirizzi

The number of patients with complicated forms of cholelithiasis of cholelithiasis is progressively growing. One of the complications of gallstone disease is Mirizzi syndrome (SM). The reason for the development of which is the spread of the inflammatory - destructive process from the gallbladder to the bile ducts with the formation of pressure ulcers in the common bile duct, as a result of which the formation of a cholecystobiliary fistula occurs, through which stones from the gallbladder enter the main bile ducts. The analysis of the surgical treatment of patients with cholelithiasis (GSD) treated in the UH NJSC "MUS" was carried out. There were 3842 patients in total, Patients were in the period from January 2012. to July 2018 The analysis revealed that of all these patients with gallstones, Mirizzi SM type III and IV syndrome was diagnosed in 25 (0.7%). In 14 (56%) patients with type III SM and type IV SM, 11 (44%). The main group consisted of 10 (40%) patients and 15 (60%) patients included in the control group. The main group completed: 1) In type III SM (only 4 (40%) patients). One patient underwent hepaticojejunostomy according to the clinic method (2017/0423.1). In 3 patients, cholecystohepaticocholedochoplasty was performed with U-shaped interrupted sutures on the drainage according to Vishnevsky (2017 / 0980.1); 2) In type IV SM (a total of 6 (60%) patients). 4 patients underwent hepaticojejunostomy according to the clinic method (2017/0423.1). In 2 patients, cholecystohepaticocholedochoplasty was performed with U-shaped interrupted sutures on the drainage according to Vishnevsky (2017 / 0980.1). The developed and tested methods of surgical treatment of Mirizzi syndrome of types III and IV make it possible to improve the immediate and long-term results of surgical treatment of patients with this pathology. These methods of surgical treatment allow preserving the physiology of the bile outflow without postoperative complications typical for traditional hepaticojejunostomy (incompetence of the anastomotic sutures, stricture of hepaticojejunostomy).

Quality of life of treated patients with Mirizi syndrome

Objective. To compare the quality of life of patients with spontaneous internal biliary fistula (SIBF) and without them, before and after surgery.
 Materials and methods. 82 (38.7%) patients were diagnosed with Mirizzi syndrome (MS) type I, and 130 (61.3%) patients with type II (II-V) type MS. During the study, the classification of A. Csendes - M. Beltran was used. By sex, patients were distributed as follows: there were 68 men (32.0%), women - 144 (68.0%). The age of patients ranged from 37 to 80 years (average - 66.4 years). The GSRS (Gastrointestinal Symptom Rating Scale) questionnaire was used to assess quality of life. When comparing groups, the use of Student's T test comparative mean values and quadratic deviations. The reliability of the obtained p values were checked by the method of Bonferoni and False Discovery Rate (FDR).
 Results. Multiple comparisons with Bonferon and FDR correction revealed statistically significant differences in the results between QOL of patients with MS I and II both before and after surgery. When compared on the scale of total measurement, it was found that the quality of life of patients without SIBF improved by 11% after cholecystectomy in MS I type. When comparing the results of QOL assessment before and after surgery in patients with type II MS, it was found that QOL after surgery in patients improved by 10% from baseline.
 Conclusions. The quality of life of patients with MS I type is higher compared to patients with SIBF both before and after surgery (p=0.0001), which is due to impaired bile duct and gastrointestinal tract in SIBF. Elimination of SIBF improves the level of QOL of patients by 10%, which is characterized by a decrease in all items of the GSRS scale.

“Difficult Gallbladder” Incidence and Management at Speciality Surgical Unit

Laparoscopic cholecystectomy is deemed to common surgical procedure, however 'Difficult Gallbladder' requires modified surgical approach. Aim: 1. To define incidence of "difficult gallbladder“ 2. To review bail out procedures for difficult gallbladder Study period: January 2016 to December 2019. “Difficult gall bladder” defined as: 1. acute cholecystitis with thick walled/necrotic/gangrenous/empyema of gall bladder. 2. chronic cholecystitis (fused calots triangle with thick contracted gallbladder). 3. Mirizzi syndrome. 4. Known/ suspected GB perforation. Subtotal cholecystectomy defined as: 1. constituting type: infundibular stump cleared and suture closed. 2. Fenestrating type posterior wall on GB bed left behind and cystic duct closed. Results: Total 745 patients underwent cholecystectomy. Out of 227 cases of acute cholecystitis, there were 119 cases were “difficult gallbladder”. Etiology of difficult gallbladder was as follows, Empyma gall bladder-46, Gangreneous/necrotic gall bladder-20, Chronic cholecystitis with fused calot's triangle-24, Mirizzi syndrome type I/II-8, Gall bladder perforation-21. Out of 119, difficult gallbladder, subtotal cholecystectomy was done in 74 cases-Fenestrating type in 49 cases while constituting type in 25 cases. There was no bile duct injury reported. Bile leak was encountered in 4 cases of constituting type of subtotal cholecystectomy, which was stopped gradually without any intervention. Conclusion: It is advisable to look for cystic duct identification and close the duct whenever is possible. Subtotal cholecystectomy is viable bail out option in difficult gallbladder surgery to prevent bile duct injury.

Robotic Management of Mirizzi Syndrome Type IV with Cholecystocolic Fistula: A Rare Case Report

Robotic Management of Mirizzi Syndrome Type IV with Cholecystocolic Fistula: A Rare Case Report

S3326 A Rare Case of Type 1 Mirizzi Syndrome

INTRODUCTION: Mirizzi syndrome is described as an obstruction of the common hepatic duct secondary to extrinsic compression from a retained gallstone in the cystic duct or gallbladder infundibulum. Common presenting symptoms include right upper quadrant pain, fevers and jaundice. There is an estimated occurrence of 0.05 to 4% in patients undergoing surgery for cholelithiasis with Type 1 occurring in 11% percent of those cases. Here we present a case of a 39 year old female diagnosed with Mirizzi syndrome, along with a review of literature. CASE DESCRIPTION/METHODS: A 39 year old female initially presented with RUQ/mid epigastric pain with radiation to her back associated with jaundice, nausea and vomiting. Physical exam significant for RUQ guarding and diffuse tenderness to palpation. Labs showed elevated Alk Phos 143, ALT 577 and AST 612. Patient had undergone laparoscopic cholecystectomy 2 weeks prior with subsequent biloma formation which was drained. MRCP on current presentation showed a 9mm filling defect at junction of cystic duct and common hepatic duct with narrowing. HIDA showed nonvisualization of the common bile duct. Patient underwent open surgical exploration with removal of 2 stones causing extrinsic common hepatic duct obstruction. The patient had a significant reduction of symptoms 4-6 hours after the procedure, with complete resolution within 72 hours. Patient was transitioned from Piperacillin-Tazobactam to oral Amoxicillin/Clavulanic Acid and was discharged. DISCUSSION: This case is classified as Type 1 due to external compression of the common hepatic duct. The aforementioned compression can be complicated by a cholecystocholedochal fistula, which occurs in Mirizzi syndrome Type 2. Mirizzi syndrome is often underdiagnosed prior to surgery, often leading to iatrogenic damage. Laparoscopic surgery is a challenge due to the presence of dense adhesions and inflammation causing distortion of the biliary anatomy. Literature supports an attempt at laparoscopic surgery with a low threshold for conversion to open cholecystectomy.

Endoscopic Nasogallbladder Drainage Combined with Laparoscopic Surgery for Type I Mirizzi Syndrome with Acute Cholecystitis: A Case Series Report.

Objective To investigate the safety and feasibility of endoscopic nasogallbladder drainage (ENGBD) combined with laparoscopic surgery for Mirizzi syndrome type I with acute cholecystitis. Methods An analysis of 4 patients with type I Mirizzi syndrome with acute cholecystitis admitted to the First Hospital of Jilin University. Results The patients underwent ENGBD, and laparoscopic surgery was evaluated postoperatively. All four patients successfully recovered from this combined surgical approach. Conclusion The combination of ENGBD and laparoscopic surgery is safe and feasible for the treatment of patients with type I Mirizzi syndrome accompanied by acute cholecystitis. This approach may reduce the traumatic stress on patients and is worthy of widespread implementation.

Role of ERCP in Diagnosis and Treatment of Type I Mirizzi Syndrome: A Case Series with Review of Literature

Background/aim: Mirizzi syndrome is a rare condition complicating long-standing gallstones disease. The aim of this study is to define, through a 17 year-experience, the role of Endoscopic Retrograde Cholangiopancreatography in the diagnosis and the treatment of Mirizzi syndrome type I according to Csendes classification. Materials and Methods: A retrospective study including patients diagnosed with Mirizzi syndrome type I, between 2002 and 2019 was conducted in the department of digestive endoscopy of our university hospital. Data collected included demographic, clinical, biological and imaging findings. Endoscopic characteristics and procedures used for treatment were collected. Statistical analysis was performed using SPSS 20.0. Results: Type I Mirizzi syndrome was diagnosed during ERCP in 0,48% of patients with gallstone disease, the median age was 55.5 (46-69.5) without gender difference. 50% of our cases were diagnosed before surgery. Endoscopic therapeutic procedures included biliary decompression techniques using nasal bile drainage or plastic stents, balloon sweeping after selective catheterization of cystic duct and large balloon papillary dilation with double cannulation. The success rate of endoscopic management was 66,6%. Surgical treatment was performed at the same time as laparoscopic cholecystectomy in patients with lithiasic gall bladder. Conclusions: Mirizzi syndrome remains a fascinating and rare condition complicating gallstone disease with no uniform guidelines to date. Our study emphasizes the role of ERCP as a diagnostic and therapeutic procedure in the management of type I Mirizzi syndrome.

Mirizzi syndrome management (in Russian only)

To assess an effectiveness of complex preoperative diagnosis, conservative treatment, minimally invasive biliary decompression for Mirizzi syndrome and to analyze surgical outcomes depending on the effectiveness of minimally invasive biliary decompression. There were 67 patients with Mirizzi syndrome aged 27-96 years (mean age -64.8 years). The diagnosis was established on the basis of complaints, objective data, laboratory survey, abdominal X-ray, ultrasound (US), endoscopic gastroduodenoscopy (EGDS), computed tomography (CT) and magnetic resonance imaging (MRI). Extrahepatic bile duct visualization in case of suspected biliodigestive fistula was achieved by using of percutaneous transhepatic cholangiography, endoscopic retrograde cholangiopancreatography, cholecystocholangiography, intraoperative cholangiography. The analysis of the diagnosis and treatment of patients with Mirizzi syndrome and mechanical jaundice with and without symptoms of cholangitis was carried out. It should be noted that percutaneous transhepatic cholangiography and cholecystocholangiography with antegrade contrasting were able to confirm Mirizzi syndrome type 1 without complications. Retrograde cholangiopancreatography in patients with Mirizzi syndrome type 2 reduced the diagnostic value of contrast-enhancement with complications in every fifth patient. Percutaneous drainage for Mirizzi syndrome type 1 was effective in all patients. There was low effectiveness of medication for Mirizzi syndrome. Medication combined with antegrade biliary decompression was 7 times more effective than retrograde decompression. All patients underwent surgery. Mortality depended on surgical emergency and effectiveness of biliary decompression. So, emergency interventions were followed by mortality rate near 60% while there were no deaths after elective procedures. Overall mortality was 11.9%.