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Kawai H, Sato T, Natsui M, Watanabe K, Inoue R, Kimura M, Yoko K, Sasaki SY, Watanabe M, Ohashi T, Tsukahara A, Tanaka N, Tsukada Y. Mirizzi Syndrome Type IV Successfully Treated with Peroral Single-operator Cholangioscopy-guided Electrohydraulic Lithotripsy: A Case Report with Literature Review. Intern Med 2022; 61:3513-3519. [PMID: 35569988 PMCID: PMC9790796 DOI: 10.2169/internalmedicine.9526-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
A 76-year-old man presented with liver dysfunction and intrahepatic bile duct dilatation. Imaging studies showed two large stones that had become impacted in the common hepatic duct, which was fused with the gallbladder. The patient was diagnosed with Mirizzi syndrome type IV. Hepaticojejunostomy and stone removal failed due to dense gallbladder adhesions involving the right hepatic artery. The bile flow was temporarily restored; however, the patient experienced cholangitis 16 months later. The stones were extracted via peroral single-operator cholangioscopy (SOC)-guided electrohydraulic lithotripsy. This is the first case in which stones were completely removed by SOC-guided treatment in a patient with Mirizzi syndrome type IV.
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Affiliation(s)
- Hirokazu Kawai
- Department of Internal Medicine, Niigata Prefectural Shibata Hospital, Japan
| | - Toshifumi Sato
- Department of Internal Medicine, Niigata Prefectural Shibata Hospital, Japan
| | - Masaaki Natsui
- Department of Internal Medicine, Niigata Prefectural Shibata Hospital, Japan
| | - Kotaro Watanabe
- Department of Internal Medicine, Niigata Prefectural Shibata Hospital, Japan
| | - Ryosuke Inoue
- Department of Internal Medicine, Niigata Prefectural Shibata Hospital, Japan
| | - Mayuki Kimura
- Department of Internal Medicine, Niigata Prefectural Shibata Hospital, Japan
| | - Kazumi Yoko
- Department of Internal Medicine, Niigata Prefectural Shibata Hospital, Japan
| | - Syun-Ya Sasaki
- Department of Internal Medicine, Niigata Prefectural Shibata Hospital, Japan
| | - Masashi Watanabe
- Department of Internal Medicine, Niigata Prefectural Shibata Hospital, Japan
| | - Taku Ohashi
- Department of Surgery, Niigata Prefectural Shibata Hospital, Japan
| | | | - Norio Tanaka
- Department of Surgery, Niigata Prefectural Shibata Hospital, Japan
| | - Yoshihisa Tsukada
- Department of Internal Medicine, Niigata Prefectural Shibata Hospital, Japan
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Yu T, Li Y, Hou S, Zhang L, Tian J, Hou S. Diagnostic challenge: Mirizzi syndrome with anomalous pancreaticobiliary junction. Endoscopy 2022; 54:E974-E976. [PMID: 35913066 PMCID: PMC9736870 DOI: 10.1055/a-1882-5137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Tingting Yu
- Department of Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, P. R. China
| | - Yaoting Li
- Department of Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, P. R. China
| | - Suning Hou
- Department of Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, P. R. China
| | - Lichao Zhang
- Department of Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, P. R. China
| | - Jiao Tian
- Department of Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, P. R. China
| | - Senlin Hou
- Department of Biliopancreatic Endoscopic Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, P. R. China
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Li J, Guo SJ, Zhang JC, Wang HY, Li K, Xu CS, Wang XF. Novel peroral cholangioscopy-directed lithotripsy using an ultraslim upper endoscope for refractory Mirizzi syndrome: A case report. Medicine (Baltimore) 2020; 99:e22649. [PMID: 33157920 PMCID: PMC7647584 DOI: 10.1097/md.0000000000022649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
RATIONALE Mirizzi syndrome (MS) is an uncommon condition characterized by common hepatic duct (CHD) compression by an impacted gallbladder or cystic duct stones or adjacent inflammation. To date, a standardized therapeutic strategy for MS has not been established yet, owing to its complex clinical presentation. Thus, researchers still have to develop new optimized approaches to solve this problem. Herein, we describe a patient with refractory MS who underwent a successful treatment by novel hybrid anchoring balloon-guided direct peroral cholangioscopy (POC) using an ultraslim endoscope. PATIENT CONCERNS A 56-year-old man with a history of biliary stone was referred to our hospital for complaints of discomfort in the right upper quadrant of the abdomen and obstructive jaundice. Endoscopic retrograde cholangiopancreatography showed an 18-mm impacted stone at the level of the cystic duct, which compressed the CHD. The CHD had local stricture, with its upstream and intrahepatic bile duct dilation. DIAGNOSES He was diagnosed with type I MS. INTERVENTIONS Initially, the patient received an endoscopic major sphincterotomy. However, conventional stone extraction, including mechanical lithotripsy, was unsuccessful. Then, after signing the informed consent form for further treatment, he was successfully treated with novel hybrid anchoring balloon-guided direct POC. OUTCOMES The patient had no operative complications and was discharged with cleared ducts. At the 3-year follow-up, he was asymptomatic. LESSONS Our novel hybrid anchoring balloon-guided direct POC may be an effective alternative treatment approach for difficult gallbladder cases, such as refractory MS.
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Desai GS, Pande P, Narkhede R, Wagle P. Late postcholecystectomy Mirizzi syndrome due to a sessile gall bladder remnant calculus managed by laparoscopic completion cholecystectomy: a feasible surgical option. BMJ Case Rep 2019; 12:12/8/e228156. [PMID: 31387861 DOI: 10.1136/bcr-2018-228156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
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.
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Affiliation(s)
- Gunjan S Desai
- Department of Gastrointestinal Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Prasad Pande
- Department of Gastrointestinal Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Rajvilas Narkhede
- Department of Gastrointestinal Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Prasad Wagle
- Department of Gastrointestinal Surgery, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India
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Cheung FHV, Mak CCC, Chu WY, Fan N, Lui KW. A case of type II Mirizzi syndrome treated by simple endoscopic means. J Surg Case Rep 2018; 2018:rjy257. [PMID: 30310644 PMCID: PMC6174627 DOI: 10.1093/jscr/rjy257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/13/2018] [Indexed: 11/13/2022] Open
Abstract
Mirizzi syndrome is an uncommon complication of chronic cholelithiasis. Advancement in radiological modalities and minimally invasive surgery has led to improved pre-operative diagnoses and more laparoscopic cholecystectomies. But for unsuitable surgical candidates, endoscopy can be the definitive treatment. In this case, we present a 67-year-old man with type II Mirizzi syndrome treated by simple endoscopic means.
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Affiliation(s)
| | | | - Wai Yin Chu
- Department of Surgery, Yan Chai Hospital, Hong Kong, China
| | - Ning Fan
- Department of Surgery, Yan Chai Hospital, Hong Kong, China
| | - Ka Wing Lui
- Department of Surgery, Yan Chai Hospital, Hong Kong, China
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Abstract
Mirizzi Syndrome is a rare and challenging clinical entity to manage. However, recent advances in technology have provided surgeons with new options for more effective diagnosis and treatment of this condition. This paper reviews these new diagnostic modalities and treatment approaches for the management of Mirizzi Syndrome.An online search language was performed using PubMed and Web of Science for literature published in English between 2012 and 2017 using the search terms "Mirizzi Syndrome" and "Mirizzi." In total, 16 case series and 11 case reports were identified and analyzed.The most frequently used diagnostic modalities were ultrasound, computed tomography (CT); magnetic resonance cholangiopancreaticography (MRCP); endoscopic retrograde cholangiopancreaticography (ERCP). A combination of ≥2 diagnostic modalities was frequently used to detect Mirizzi Syndrome. Literature shows that the specific type of Mirizzi Syndrome determined the type of treatment chosen. Open surgery was the preferred option, although there are documented cases of the use of minimally-invasive techniques, even in advanced cases. Laparoscopic, endoscopic or robot-assisted surgery, used individually or in combination with lithotripsy, were all associated with a favorable outcome.As yet, there are no internationally-accepted guidelines for the management of Mirizzi Syndrome. Laparotomy is the preferred surgical technique of choice, although an increasing number of surgeons are beginning to opt for minimally-invasive techniques. The number of papers in the existing literature describing diagnostic and treatment procedures is relatively small at present, thus making it difficult to reasonably propose an evidence-based standard of care for Mirizzi Syndrome.
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Affiliation(s)
- Hang Chen
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ernest Amos Siwo
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Megan Khu
- Department of Psychological and Brain Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Yu Tian
- Department of General Surgery, Shengjing Hospital of China Medical University, Shenyang, China
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Chuang SH, Yeh MC, Chang CJ. Laparoscopic transfistulous bile duct exploration for Mirizzi syndrome type II: a simplified standardized technique. Surg Endosc 2016; 30:5635-5646. [PMID: 27129551 DOI: 10.1007/s00464-016-4911-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 04/02/2016] [Indexed: 02/05/2023]
Abstract
BACKGROUND Laparoscopic treatment is a viable option for Mirizzi syndrome (MS) type I, but it is not recommended for MS type II (McSherry classification). We introduce laparoscopic transfistulous bile duct exploration (LTBDE) as a simplified standardized technique for MS type II. METHODS Eleven consecutive LTBDEs performed by a surgeon for MS type II were analyzed retrospectively, including three successful single-incision LTBDEs (SILTBDEs). Transfistulous stone removal followed by primary closure of gallbladder remnant and partial cholecystectomy was performed. An additional choledochotomy was required in one patient. RESULTS Preoperative endoscopic retrograde cholangiopancreatography and operative findings confirmed the diagnosis of MS in five and five patients, respectively. Preoperative ultrasound implied the remaining diagnosis. The operative time was 270.5 ± 65.5 min. The stone clearance rate was 100 %. The postoperative length of hospital stay was 5.1 ± 2.2 days. There was no open conversion. Overall complications comprised two postoperative transient hyperamylasemia (18.2 %) and one superficial wound infection (9.1 %). Compared with the other group of 92 patients who underwent laparoscopic bile duct exploration, the MS type II group had a significantly younger age, a higher jaundice rate, a lower single-incision laparoscopic approach rate, a lower choledochotomy rate, longer operative time, a lower postoperative pethidine dose, and a longer total length of hospital stay. The average follow-up period was 12.1 months. CONCLUSIONS LTBDE is safe and efficacious for MS type II including Csendes type IV. A high suspicion of MS is critical. SILTBDE is feasible in selected cases. Long-term follow-up is mandatory.
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Affiliation(s)
- Shu-Hung Chuang
- Department of Surgery, MacKay Memorial Hospital, Hsin-Chu Branch, No. 690, Sec. 2, Guangfu Road, Hsin-Chu, 30071, Taiwan
- Department of Healthcare Management, Yuanpei University of Medical Technology, Hsin-Chu, Taiwan
| | - Meng-Ching Yeh
- Department of Surgery, MacKay Memorial Hospital, Hsin-Chu Branch, No. 690, Sec. 2, Guangfu Road, Hsin-Chu, 30071, Taiwan
| | - Chien-Jen Chang
- Department of Surgery, MacKay Memorial Hospital, Hsin-Chu Branch, No. 690, Sec. 2, Guangfu Road, Hsin-Chu, 30071, Taiwan.
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Advances in Therapeutic Cholangioscopy. Gastroenterol Res Pract 2016; 2016:5249152. [PMID: 27403156 PMCID: PMC4925961 DOI: 10.1155/2016/5249152] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 04/11/2016] [Accepted: 04/18/2016] [Indexed: 12/15/2022] Open
Abstract
Nowadays, cholangioscopy is an established modality in diagnostic and treatment of pancreaticobiliary diseases. The more widespread use and the recent development of new technologies and accessories had renewed the interest of endoscopic visualization of the biliary tract, increasing the range of indications and therapeutic procedures, such as diagnostic of indeterminate biliary strictures, lithotripsy of difficult bile duct stones, ablative techniques for intraductal malignancies, removal of foreign bodies and gallbladder drainage. These endoscopic interventions will probably be the last frontier in the near future. This paper presents the new advances in therapeutic cholangioscopy, focusing on the current clinical applications and on research areas.
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