1
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Zhang Q, Xu XJ, Wang DS, Zhang YM. Repair of gall bladder-right hepatic duct fistula using the ligamentum teres hepatis: A case report. Asian J Surg 2024; 47:4587-4588. [PMID: 39085030 DOI: 10.1016/j.asjsur.2024.07.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Affiliation(s)
- Qi Zhang
- Department of General Surgery, Anqing Municipal Hospital, Anqing, 246000, PR China
| | - Xiu-Juan Xu
- Department of Critical Medicine, Anqing Municipal Hospital, Anqing, 246000, PR China
| | - Dong-Shu Wang
- Department of General Surgery, Anqing Municipal Hospital, Anqing, 246000, PR China
| | - Ya-Ming Zhang
- Department of General Surgery, Anqing Municipal Hospital, Anqing, 246000, PR China.
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2
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Kelshikar S, Athavale V, Parekh RA. Mirizzi Syndrome and Its Surgical Interventions: A Case Report. Cureus 2024; 16:e66680. [PMID: 39268291 PMCID: PMC11390951 DOI: 10.7759/cureus.66680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 08/12/2024] [Indexed: 09/15/2024] Open
Abstract
A rare side effect of cholelithiasis, called Mirizzi syndrome (MS), arises when gallstones that are impacted in the Hartmann's pouch or the cystic duct extrinsically compress the common bile duct. This condition is typically managed with a cholecystectomy. In this case report, different surgical approaches are described according to each type of Mirizzi. We report a 62-year-old female who presented with abdominal pain. She underwent endoscopic retrograde cholangiopancreaticography (ERCP) and was diagnosed with MS. We performed a subtotal cholecystectomy with a choledochoduodenostomy.
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Affiliation(s)
- Saili Kelshikar
- General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University), Pune, IND
| | - Virendra Athavale
- General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University), Pune, IND
| | - Rushabh A Parekh
- General Surgery, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University), Pune, IND
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3
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Sui X, Li M, Zhang D. Clinical Outcomes and Treatment Strategy of Mirizzi's Syndrome Treated With Surgery. Am Surg 2024:31348241267955. [PMID: 39089732 DOI: 10.1177/00031348241267955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
BACKGROUND There is currently no standardized treatment for Mirizzi's syndrome (MS). We aim to explore the surgical treatment strategy for MS by analyzing its clinical characteristics and treatment outcomes. METHODS This retrospective study analyzed the clinical data of 130 patients with MS who underwent surgery at our hospital from April 2013 to April 2020. RESULTS The study population comprised 130 patients with MS, with an approximately balanced sex ratio and a median age of 58.5 years. The preoperative diagnostic rate was 82.3%. The diagnostic accuracy of ERCP was 92.5%, higher than that of MRCP and ultrasound. All patients underwent surgical treatment, with 74 cases of laparoscopic surgery, 43 cases of laparotomy, and 13 cases of laparoscopic surgery converted to laparotomy. A total of 23 patients experienced short-term and long-term complications after surgery, with a complication rate of 17.7%. There was no statistical difference between laparoscopic surgery and open surgery in terms of intraoperative hemorrhage, operative time, and postoperative complication rate. However, the length of hospital stay was shorter in the laparoscopic surgery compared to the open surgery, which was statistically different from each other. CONCLUSION ERCP is the gold standard for the diagnosis of MS, especially for identifying the type of MS. ERCP plays an important role in both the preoperative and postoperative phases of MS. Our study demonstrated that laparoscopic surgery was a safe and feasible option for MS treatment, even requires less hospitalization than open surgery.
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Affiliation(s)
- Xiaojun Sui
- Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China
| | - Ming Li
- Tianjin NanKai Hospital, Tianjin, China
| | - Dapeng Zhang
- Tianjin Nankai Hospital, Tianjin Medical University, Tianjin, China
- Tianjin NanKai Hospital, Tianjin, China
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4
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Rojas A, Paterakos P, Hogg ME. Robotic Roux-en-Y hepaticojejunostomy for Mirizzi Syndrome (with video). J Visc Surg 2024; 161:214-216. [PMID: 38103977 DOI: 10.1016/j.jviscsurg.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Affiliation(s)
- Aram Rojas
- NorthShore University HealthSystem, Department of Surgery, Division of HPB Surgery, Evanston, IL, USA.
| | - Pierce Paterakos
- NorthShore University HealthSystem, Department of Surgery, Division of HPB Surgery, Evanston, IL, USA
| | - Melissa E Hogg
- NorthShore University HealthSystem, Department of Surgery, Division of HPB Surgery, Evanston, IL, USA
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5
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Moreira M, Carvalho AC, Tarrio I, Andrade AJ, Araújo T, Lopes L. Cholangioscopy with Laser Lithotripsy in the Treatment of a Patient with Type II Mirizzi Syndrome. GE PORTUGUESE JOURNAL OF GASTROENTEROLOGY 2024; 31:209-211. [PMID: 38836123 PMCID: PMC11149984 DOI: 10.1159/000533498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/21/2023] [Indexed: 06/06/2024]
Affiliation(s)
- Marta Moreira
- Department of Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal
| | - Ana Catarina Carvalho
- Department of Gastroenterology, Centro Hospitalar Tondela-Viseu, Dão Lafões, Portugal
| | - Isabel Tarrio
- Department of Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal
| | - Alda João Andrade
- Department of Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal
| | - Tarcísio Araújo
- Department of Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal
| | - Luís Lopes
- Department of Gastroenterology, Hospital de Santa Luzia, Viana do Castelo, Portugal
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- ICVS/3B's - PT Government Associate Laboratory, Braga/Guimaraes, Portugal
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6
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Froehlich M, Sodomin EM, Fontenot T, Iftekhar N, Chan CN, Barber A. Mirizzi syndrome: The Trojan horse of gallbladder disease. Surg Open Sci 2024; 18:103-106. [PMID: 38464911 PMCID: PMC10920953 DOI: 10.1016/j.sopen.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 02/15/2024] [Accepted: 02/20/2024] [Indexed: 03/12/2024] Open
Abstract
Background The incidence of Mirizzi Syndrome ranges from 0.05 to 5.7 % of patients who undergo cholecystectomy. The purpose of this study is to examine the preoperative workup and postoperative outcomes for patients diagnosed with Mirizzi Syndrome. Methods Retrospective chart review was conducted between January 2018 and January 2022 at a single institution. All adult patients who underwent cholecystectomy were included. Results 1628 patients underwent cholecystectomy of which 47 were diagnosed with Mirizzi Syndrome. The majority of patients had type 1 Mirizzi Syndrome. Preoperative studies were often nondiagnostic and 81 % of cases were diagnosed intraoperatively. 66 % of cases were performed laparoscopically, an open approach was required for type V Mirizzi Syndrome. The complication rate was 25 %; most commonly a bile leak requiring ERCP. Conclusion Mirizzi syndrome is more common than previously expected and related to patient's ability to seek timely medical care. Most cases can be completed laparoscopically however there is a high rate of complications. Key message This study presents an additional cohort of patients found to have Mirizzi syndrome and supports the hypothesis that it is difficult to diagnose preoperatively. Cases should be attempted laparoscopically but there remains a high complication rate.
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Affiliation(s)
- Mary Froehlich
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, United States of America
| | - Elizabeth M. Sodomin
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, United States of America
| | - Taylor Fontenot
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, United States of America
| | - Noama Iftekhar
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, United States of America
| | - Christian N. Chan
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, United States of America
| | - Annabel Barber
- Kirk Kerkorian School of Medicine at UNLV, Las Vegas, NV, United States of America
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7
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Duhancioglu G, Arif-Tiwari H, Natali S, Reynolds C, Lalwani N, Fulcher A. Traveling gallstones: review of MR imaging and surgical pathology features of gallstone disease and its complications in the gallbladder and beyond. Abdom Radiol (NY) 2024; 49:722-737. [PMID: 38044336 DOI: 10.1007/s00261-023-04107-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 12/05/2023]
Abstract
Gallstone-related disease comprises a spectrum of conditions resulting from biliary stone formation, leading to obstruction and inflammatory complications. These can significantly impact patient quality of life and carry high morbidity if not accurately detected. Appropriate imaging is essential for evaluating the extent of gallstone disease and assuring appropriate clinical management. Magnetic Resonance Imaging (MRI) techniques (including Magnetic Resonance Cholangiopancreatography (MRCP) are increasingly used for diagnosis of gallstone disease and its complications and provide high contrast resolution and facilitate tissue-level assessment of gallstone disease processes. In this review we seek to delve deep into the spectrum of MR imaging in diagnose of gallstone-related disease within the gallbladder and complications related to migration of the gallstones to the gall bladder neck or cystic duct, common hepatic duct or bile duct (choledocholithiasis) and beyond, including gallstone pancreatitis, gallstone ileus, Bouveret syndrome, and dropped gallstones, by offering key examples from our practice. Furthermore, we will specifically highlight the crucial role of MRI and MRCP for enhancing diagnostic accuracy and improving patient outcomes in gallstone-related disease and showcase relevant surgical pathology specimens of various gallstone related complications.
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Affiliation(s)
| | - Hina Arif-Tiwari
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA.
| | - Stefano Natali
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | - Conner Reynolds
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
| | - Neeraj Lalwani
- Virginia Commonwealth University/Medical College of Medicine (VCU), Richmond, VA, USA
| | - Ann Fulcher
- Virginia Commonwealth University/Medical College of Medicine (VCU), Richmond, VA, USA
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8
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Koo JGA, Tham HY, Toh EQ, Chia C, Thien A, Shelat VG. Mirizzi Syndrome-The Past, Present, and Future. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:12. [PMID: 38276046 PMCID: PMC10818783 DOI: 10.3390/medicina60010012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 12/08/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024]
Abstract
Mirizzi syndrome is a complication of gallstone disease caused by an impacted gallstone in the infundibulum of the gallbladder or within the cystic duct, causing chronic inflammation and extrinsic compression of the common hepatic duct or common bile duct. Eventually, mucosal ulceration occurs and progresses to cholecystobiliary fistulation. Numerous systems exist to classify Mirizzi syndrome, with the Csendes classification widely adopted. It describes five types of Mirizzi syndrome according to the presence of a cholecystobiliary fistula and its corresponding severity, and whether a cholecystoenteric fistula is present. The clinical presentation of Mirizzi syndrome is non-specific, and patients typically have a longstanding history of gallstones. It commonly presents with obstructive jaundice, and can mimic gallbladder, biliary, or pancreatic malignancy. Achieving a preoperative diagnosis guides surgical planning and improves treatment outcomes. However, a significant proportion of cases of Mirizzi syndrome are diagnosed intraoperatively, and the presence of dense adhesions and distorted anatomy at Calot's triangle increases the risk of bile duct injury. Cholecystectomy remains the mainstay of treatment for Mirizzi syndrome, and laparoscopic cholecystectomy is increasingly becoming a viable option, especially for less severe stages of cholecystobiliary fistula. Subtotal cholecystectomy is feasible if total cholecystectomy cannot be performed safely. Additional procedures may be required, such as common bile duct exploration, choledochoplasty, and bilioenteric anastomosis. Conclusions: There is currently no consensus for the management of Mirizzi syndrome, as the management options depend on the extent of surgical pathology and availability of surgical expertise. Multidisciplinary collaboration is important to achieve diagnostic accuracy and guide treatment planning to ensure good clinical outcomes.
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Affiliation(s)
- Jonathan G. A. Koo
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.G.A.K.); (H.Y.T.)
| | - Hui Yu Tham
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.G.A.K.); (H.Y.T.)
| | - En Qi Toh
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore;
| | - Christopher Chia
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, Singapore 308433, Singapore;
| | - Amy Thien
- Department of General Surgery, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan BA 1710, Brunei;
| | - Vishal G. Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore; (J.G.A.K.); (H.Y.T.)
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 308232, Singapore;
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9
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Fujita N, Yasuda I, Endo I, Isayama H, Iwashita T, Ueki T, Uemura K, Umezawa A, Katanuma A, Katayose Y, Suzuki Y, Shoda J, Tsuyuguchi T, Wakai T, Inui K, Unno M, Takeyama Y, Itoi T, Koike K, Mochida S. Evidence-based clinical practice guidelines for cholelithiasis 2021. J Gastroenterol 2023; 58:801-833. [PMID: 37452855 PMCID: PMC10423145 DOI: 10.1007/s00535-023-02014-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
The Japanese Society of Gastroenterology first published evidence-based clinical practice guidelines for cholelithiasis in 2010, followed by a revision in 2016. Currently, the revised third edition was published to reflect recent evidence on the diagnosis, treatment, and prognosis of cholelithiasis conforming to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Following this revision, the present English version of the guidelines was updated and published herein. The clinical questions (CQ) in the previous version were reviewed and rearranged into three newly divided categories: background questions (BQ) dealing with basic background knowledge, CQ, and future research questions (FRQ), which refer to issues that require further accumulation of evidence. Finally, 52 questions (29 BQs, 19 CQs, and 4 FRQs) were adopted to cover the epidemiology, pathogenesis, diagnosis, treatment, complications, and prognosis. Based on a literature search using MEDLINE, Cochrane Library, and Igaku Chuo Zasshi databases for the period between 1983 and August 2019, along with a manual search of new information reported over the past 5 years, the level of evidence was evaluated for each CQ. The strengths of recommendations were determined using the Delphi method by the committee members considering the body of evidence, including benefits and harms, patient preference, and cost-benefit balance. A comprehensive flowchart was prepared for the diagnosis and treatment of gallbladder stones, common bile duct stones, and intrahepatic stones, respectively. The current revised guidelines are expected to be of great assistance to gastroenterologists and general physicians in making decisions on contemporary clinical management for cholelithiasis patients.
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Affiliation(s)
- Naotaka Fujita
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan.
- Miyagi Medical Check-up Plaza, 1-6-9 Oroshi-machi, Wakabayashi-ku, Sendai, Miyagi, 984-0015, Japan.
| | - Ichiro Yasuda
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Itaru Endo
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Hiroyuki Isayama
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Takuji Iwashita
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Toshiharu Ueki
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Kenichiro Uemura
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Akiko Umezawa
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Akio Katanuma
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Yu Katayose
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Yutaka Suzuki
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Junichi Shoda
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Toshio Tsuyuguchi
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Toshifumi Wakai
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Kazuo Inui
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Michiaki Unno
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Yoshifumi Takeyama
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Takao Itoi
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Kazuhiko Koike
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
| | - Satoshi Mochida
- Guidelines Committee for Creating and Evaluating the "Evidence-Based Clinical Practice Guidelines for Cholelithiasis'', The Japanese Society of Gastroenterology, 6F Shimbashi i-MARK Building, 2-6-2 Shimbashi, Minato-ku, Tokyo, 105-0004, Japan
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10
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Quang PV, Lai VT, Cuong DC, Duc NM. Laparoscopic treatment of Mirizzi syndrome with subtotal cholecystectomy and electrohydraulic lithotripsy: A case report. Radiol Case Rep 2023; 18:2667-2672. [PMID: 37287723 PMCID: PMC10241654 DOI: 10.1016/j.radcr.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/01/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
Mirizzi syndrome is a rare chronic cholecystitis complication. However, the current consensus on managing this condition remains controversial, especially through laparoscopic surgery. This report describes the feasibility of treating type I Mirizzi syndrome with laparoscopic subtotal cholecystectomy and electrohydraulic lithotripsic gallstone removal. A 53-year-old woman presented with dark urine and right upper quadrant pain for 1 month. On examination, she was jaundiced. Blood tests showed highly elevated liver and biliary enzyme levels. Abdominal ultrasound showed a slightly dilated common bile duct with suspicion of choledocholithiasis. However, endoscopic retrograde cholangiopancreatography showed a narrowed common bile duct extrinsically compressed by a gallstone in the cystic duct, establishing a Mirizzi syndrome diagnosis. Elective laparoscopic cholecystectomy was planned. At operation, the trans-infundibulum approach was used since dissection around the cystic duct was difficult due to severe local inflammation of Calot's triangle. The gallbladder's neck was opened, and the stone was removed by lithotripsy via a flexible choledochoscope. Common bile duct exploration through the cystic duct was normal. The fundus and body of the gallbladder were resected, followed by T-tube drainage and suturing of the gallbladder's neck. The patient's postoperative clinical course was uneventful. Treating Mirizzi syndrome remains a major challenge for hepatobiliary specialists even with open surgery due to high complication rates, including bile duct injuries. Treatment is primarily to clear out the responsible stone and necrotic tissue. Due to advances in endoscopic surgery and equipment, subtotal cholecystectomy with laparoscopic gallstone extraction provides a safe and effective option for patients with Mirizzi syndrome. Laparoscopic subtotal cholecystectomy with electrohydraulic lithotripsy is a feasible and useful approach for treating Mirizzi syndrome that avoids iatrogenic bile duct injury.
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Affiliation(s)
- Pham Vinh Quang
- Department of Hepatobiliary and Pancreatic Surgery, Binh Dan Hospital, Ho Chi Minh City, Vietnam
| | - Vo Thien Lai
- Department of Hepatobiliary and Pancreatic Surgery, Binh Dan Hospital, Ho Chi Minh City, Vietnam
| | - Dam Chi Cuong
- Department of Radiology, Binh Dan Hospital, Ho Chi Minh City, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, 2 Duong Quang Trung Ward 12 Distric..., Ho Chi Minh City, 700000, Vietnam
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11
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Siddiqui WT, Schwartz H. Mirizzi syndrome. Intern Emerg Med 2023; 18:1589-1590. [PMID: 36930338 DOI: 10.1007/s11739-023-03255-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Affiliation(s)
- Waleed Tariq Siddiqui
- Department of Internal Medicine, Griffin Hospital, 130 Division Street, Derby, CT, 06418, USA.
| | - Harold Schwartz
- Department of Gastroenterology, Griffin Hospital, Derby, CT, USA
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12
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Lalountas M, Smyrlis N, Mouratidis SV, Makedos P. Mirizzi syndrome type V complicated with triple fistula: a case report. Surg Case Rep 2023; 9:110. [PMID: 37335440 DOI: 10.1186/s40792-023-01696-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/12/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Mirizzi 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 PRESENTATION A 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. CONCLUSIONS Mirizzi syndrome complicated with triple fistula, first described in the international literature, to the best of our knowledge, confirms the long natural history of inflammation.
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Affiliation(s)
| | - Nikolaos Smyrlis
- Department of Surgery, General Hospital of Polygyros, Chalkidiki, Greece.
- , 54249, Thessaloniki, Greece.
| | | | - Panagiotis Makedos
- Department of Surgery, General Hospital of Polygyros, Chalkidiki, Greece
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13
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Zhang Z, Dong J, Lin F, Wang Q, Xu Z, He X, Yang S, Li Y, Liu L, Zhang C, Liu Z, Zhao Y, Yang H, Peng S. Hotspots and difficulties of biliary surgery in older patients. Chin Med J (Engl) 2023; 136:1037-1046. [PMID: 37052140 PMCID: PMC10228479 DOI: 10.1097/cm9.0000000000002589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Indexed: 04/14/2023] Open
Abstract
ABSTRACT With the accelerated aging society in China, the incidence of biliary surgical diseases in the elderly has increased significantly. The clinical characteristics of these patients indicate that improving treatment outcomes and realizing healthy aging are worthy of attention. How to effectively improve the treatment effect of geriatric biliary surgical diseases has attracted widespread attention. This paper reviews and comments on the hotspots and difficulties of biliary surgery in older patients from six aspects: (1) higher morbidity associated with an aging society, (2) prevention and control of pre-operative risks, (3) extending the indications of laparoscopic surgery, (4) urgent standardization of minimally invasive surgery, (5) precise technological progress in hepatobiliary surgery, and (6) guarantee of peri-operative safety. It is of great significance to fully understand the focus of controversy, actively make use of its favorable factors, and effectively avoid its unfavorable factors, for further improving the therapeutic effects of geriatric biliary surgical diseases, and thus benefits the vast older patients with biliary surgical diseases. Accordingly, a historical record with the highest age of 93 years for laparoscopic transcystic common bile duct exploration has been created by us recently.
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Affiliation(s)
- Zongming Zhang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Jiahong Dong
- Department of Hepatopancreatobiliary Surgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 102218, China
| | - Fangcai Lin
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Qiusheng Wang
- Department of General Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Zhi Xu
- Department of General Surgery, Peking University Third Hospital, Beijing 100191, China
| | - Xiaodong He
- Department of General Surgical, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Shizhong Yang
- Department of Hepatopancreatobiliary Surgery, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 102218, China
| | - Youwei Li
- Department of Radiology, Beijing Rehabilitation Hospital, Capital Medical University, Beijing 100144, China
| | - Limin Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Chong Zhang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Zhuo Liu
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Yue Zhao
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Haiyan Yang
- Department of General Surgery, Beijing Electric Power Hospital, State Grid Corporation of China, Capital Medical University, Beijing 100073, China
| | - Shuyou Peng
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, China
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14
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Williams T, Maher A, Redmond K, Yeung S, Ko BS. Hemobilia in the setting of cystic artery pseudoaneurysm secondary to type I Mirizzi syndrome. Clin J Gastroenterol 2023:10.1007/s12328-023-01806-w. [PMID: 37131114 DOI: 10.1007/s12328-023-01806-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/14/2023] [Indexed: 05/04/2023]
Abstract
Hemobilia is an uncommon diagnosis and is often not suspected in the absence of recent hepatobiliary intervention or trauma. Hemobilia in the setting of cystic artery pseudoaneurysm secondary to type I Mirizzi syndrome is a rare occurrence. We report the case of a 61-year-old male who presented with epigastric pain and vomiting. Blood tests demonstrated hyperbilirubinemia with elevated inflammatory markers. Magnetic resonance cholangiopancreatography revealed type I Mirizzi syndrome in the presence of a 21 mm cystic duct stone. During endoscopic retrograde cholangiopancreatography, hemobilia was identified. Subsequent triple phase computed tomography imaging identified a 12 mm cystic artery pseudoaneurysm. Angiography with successful coiling of the cystic artery was accomplished. Cholecystectomy was performed, confirming type I Mirizzi syndrome. This case demonstrates the importance of considering ruptured pseudoaneurysm in patients presenting with evidence of upper gastrointestinal bleeding in the setting of biliary stone disease. Transarterial embolization, followed by surgical management, is effective in both the diagnosis and management of ruptured cystic artery pseudoaneurysm with associated hemobilia.
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Affiliation(s)
- Thomas Williams
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia.
- Faculty of Medicine, University of Queensland, Brisbane, Australia.
| | - Adrian Maher
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Kendal Redmond
- Department of Medical Imaging, Princess Alexandra Hospital, Brisbane, Australia
| | - Shinn Yeung
- Department of Hepatobiliary Surgery, Princess Alexandra Hospital, Brisbane, Australia
| | - Bong Suk Ko
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Brisbane, QLD, 4102, Australia
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15
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Karaahmet F, Kekilli M. Endoscopic retrograde cholangiopancreatography-oriented surgery for accomplished treatment of Mirizzi syndrome: a single-center experience. Eur J Gastroenterol Hepatol 2023; 35:537-540. [PMID: 36966768 DOI: 10.1097/meg.0000000000002534] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND Mirizzi syndrome is a gallstone disease characterized by compression of extrahepatic biliary duct with an impacted stone. Our aim is to identify and describe the incidence, clinical presentation, operative details and the association postoperative complication of Mirizzi syndrome in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). METHODS The ERCP procedures were held in Gastroenterology Endoscopy Unit and retrospectively evaluated. The patients were divided into two groups, the cholelithiasis + common bile duct (CBD) stone group and the Mirizzi syndrome group. These groups were compared with the demographic characteristics, ERCP procedures, types of Mirizzi syndrome and surgical technique. RESULTS A total of 1018 consecutive patients who underwent ERCP were scanned retrospectively. Of the 515 patients fulfilling the criteria for ERCP, 12 had Mirizzi syndrome and 503 had cholelithiasis and CBD stones. Half of the Mirizzi syndrome patients were diagnosed with pre-ERCP ultrasonography. The mean diameter of choledoc was found to be 10 mm in ERCP. ERCP-related complication rates (pancreatitis, bleeding and perforation) were the same in the two groups; 66.6% of the Mirizzi syndrome patients applied cholecystectomy and placement of T-tube surgical procedures, and there were no postoperative complications. CONCLUSION Surgery is the definitive treatment of Mirizzi syndrome. Thus patients should have a correct preoperative diagnosis for an appropriate and safe surgery. We think that ERCP could be the best guide for this. Also, we believe that intraoperative cholangiography with ERCP and hybrid procedures for guiding surgical treatment may become an advanced treatment option in the future.
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Affiliation(s)
- Fatih Karaahmet
- Department of Gastroenterology, Atilim University Medical School
| | - Murat Kekilli
- Department of Gastroenterology, Gazi University Medical School, Ankara, Turkey
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16
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Favors L, Parker M, Koontz C, Koontz O. Delayed Cholecystectomy Management for Mirizzi Syndrome. Am Surg 2023:31348231161700. [PMID: 37032533 DOI: 10.1177/00031348231161700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Mirizzi syndrome is defined as a common hepatic duct obstruction from a cystic duct stone, which results in a severe inflammatory reaction that distorts biliary anatomy and makes surgical intervention challenging. Most case reports describe an open subtotal cholecystectomy as the most common surgical technique with few reports detailing successful laparoscopic interventions. This case involves an 11-year-old African American female who presented with right upper quadrant abdominal pain and imaging consistent with Mirizzi syndrome. She was taken for a laparoscopic cholecystectomy that was quickly aborted due to extensive inflammation. She subsequently underwent endoscopic decompression of her biliary tree by gastroenterology. She returned to the operating room six weeks later for a successful interval cholecystectomy. This case illustrates a unique report of delayed cholecystectomy for management of Mirizzi syndrome, which highlights a potential management strategy that avoids technically difficult laparoscopic cholecystectomy in the acute inflammatory period.
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Affiliation(s)
- Lauren Favors
- Department of Surgery, 70274University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Mitchell Parker
- Department of Surgery, 70274University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
| | - Curt Koontz
- Department of Surgery, 70274University of Tennessee College of Medicine Chattanooga, Chattanooga, TN, USA
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17
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Won MN, Collins DP, Bouchard S, Finley C. Mirizzi Syndrome Type I: A Case Presentation. Cureus 2023; 15:e37029. [PMID: 37143632 PMCID: PMC10153761 DOI: 10.7759/cureus.37029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/02/2023] [Indexed: 05/06/2023] Open
Abstract
Mirizzi syndrome (MS) is a rare complication of chronic cholelithiasis. The syndrome describes gallstone obstruction of Hartmann's pouch or the cystic duct that extrinsically compresses the common hepatic duct, causing obstructive jaundice. In advanced cases, the gallstones may erode into the biliary tree creating a fistula, requiring prompt diagnosis and careful surgical management. We present a case of an 82-year-old female who presented with upper abdominal pain and jaundice, later diagnosed with suspected MS type I, and managed surgically. We aim to highlight MS type I because of the potential progression and damage to the bile duct, creating complications that may affect overall patient outcome.
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Affiliation(s)
- Michelle N Won
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Dylon P Collins
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Stephanie Bouchard
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, USA
| | - Christopher Finley
- Bariatric and Minimally Invasive Surgery, Fawcett Florida Memorial Hospital, Port Charlotte, USA
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18
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Stuart CM, Huey MG, Ghincea CV, Pieracci FM, Brooke M. Mirizzi syndrome complicated by type IV cholecystobiliary fistula to the right hepatic duct. JOURNAL OF MINIMALLY INVASIVE SURGERY 2023; 26:35-39. [PMID: 36936044 PMCID: PMC10020744 DOI: 10.7602/jmis.2023.26.1.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/03/2022] [Accepted: 01/09/2023] [Indexed: 03/18/2023]
Abstract
Mirizzi syndrome is a rare complication of long-term chronic cholecystitis, characterized by extrinsic compression of the common hepatic duct that may progress to development of cholecystobiliary fistula. Here we report a case of a 38-year-old female patient who underwent laparoscopic cholecystectomy with intraoperative cholangiogram for acute cholecystitis and choledocholithiasis. Intraoperatively, the patient was found to have a Mirizzi syndrome complicated by cholecystobiliary fistula to the right hepatic duct. The gallbladder was successfully removed, cholelithiasis cleared and a ureteral stent was used in reconstruction. The patient was discharged on postoperative two and was doing well on routine follow-up. Ultimately, Mirizzi syndrome is a rare clinical entity that requires careful consideration during preoperative workup and a high suspicion when abnormal anatomy is encountered intraoperatively.
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Affiliation(s)
- Christina M. Stuart
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
- Corresponding author Christina M. Stuart, Department of Surgery, University of Colorado School of Medicine, 12631 E 17th Avenue, #6117, Aurora, Colorado 80045, USA, E-mail: , ORCID: https://orcid.org/0000-0002-9851-8486
| | - Madeline G. Huey
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Christian V. Ghincea
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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19
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Mirizzi Syndrome: An Unusual Complication of Cholelithiasis. J Community Hosp Intern Med Perspect 2023; 12:79-82. [PMID: 36816165 PMCID: PMC9924651 DOI: 10.55729/2000-9666.1114] [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: 06/24/2022] [Accepted: 07/27/2022] [Indexed: 11/11/2022] Open
Abstract
Mirizzi syndrome is a rare condition caused by the obstruction of the common bile duct or common hepatic duct by external compression from multiple impacted gallstones or a single large impacted gallstone in Hartman's pouch. The condition can easily be confused with choledocholithiasis, bile duct stricture or cholangiocarcinoma due to the presence of obstructive jaundice hence may be overlooked due to the rarity of the condition. The incidence of Mirizzi syndrome among patients with gallstones is reported to range from 0.63 to 5.7%. Furthermore, it poses a differential diagnosis dilemma for the physician as well as radiologists because there are no clinical features or diagnostic procedures that have a 100% specificity and sensitivity. Laparotomy is the preferred surgical technique of choice. For the patients who are poor surgical candidate, mainstay of treatment is biliary stent placement for the restoration of normal biliary drainage. Due to low incidence of the Mirizzi syndrome, an elevated index of suspicion is required to diagnose this condition. At present, there are no well-developed, internationally recognized clinical guidelines for the management of this syndrome. Furthermore, the diagnostic procedures available still pose a barrier in the ability to confirm the diagnosis prior to surgical treatment, even though the diagnostic rate has increased dramatically.
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20
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Grohol B, Fortin GT, Ingold T, Bennett P. Mirizzi Syndrome: A Case Report. Cureus 2023; 15:e34783. [PMID: 36915851 PMCID: PMC10005894 DOI: 10.7759/cureus.34783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 02/08/2023] [Indexed: 02/10/2023] Open
Abstract
Mirizzi syndrome (MS) describes a rare complication of cholelithiasis resulting from extrinsic compression of the common hepatic duct by impacted gallstones in the cystic duct or Hartmann's pouch. MS is most commonly seen in adults and is more prevalent in the female population. Due to the pathophysiology of MS being similar to other causes of cholecystitis and biliary obstruction, the symptomatology is rather nonspecific. While ultrasound and magnetic resonance cholangiopancreatography are commonly used for diagnosis, treatment of this condition typically involves cholecystectomy. Identifying MS versus other more common causes of obstructive jaundice is paramount in limiting complications. In this report, we describe a case of MS diagnosed in a 32-year-old male who presented with nonspecific abdominal pain and other signs of obstructive jaundice. The goal of this study is to show how identifying a rare underlying cause of a common presentation can lead to improved patient outcomes.
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Affiliation(s)
- Bryce Grohol
- Medicine, Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Grayson T Fortin
- Medicine, Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Tyler Ingold
- Medicine, Liberty University College of Osteopathic Medicine, Lynchburg, USA
| | - Paul Bennett
- Internal Medicine, Centra Lynchburg General Hospital, Lynchburg, USA
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21
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Figacz A, Brazier A, Brazier J, Jamil LH, Nandalur K, Al-Katib S. Acalculous variant of Mirizzi syndrome: Imaging and clinical characteristics. Clin Imaging 2023; 94:62-70. [PMID: 36495847 DOI: 10.1016/j.clinimag.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 11/15/2022] [Accepted: 11/28/2022] [Indexed: 12/04/2022]
Abstract
PURPOSE Mirizzi Syndrome is a rare disease that causes biliary obstruction in the setting of an impacted stone in the gallbladder neck or Hartmann's Pouch which exerts mass effect on the common duct; however, we have noticed inflammatory biliary narrowing in the absence of an offending gallstone in the setting of acute cholecystitis. The purpose of this study is to report the clinical and MRCP findings in a series of 10 patients with this variant of Mirizzi Syndrome. MATERIALS AND METHODS A search of our institution's PACS and electronic medical record identified 10 patients with a diagnosis of acute cholecystitis and narrowing of the common duct on imaging in the absence of an impacted gallstone. Imaging and clinical findings were confirmed by two board-certified abdominal radiologists. RESULTS All patients presented with abdominal pain and an average elevated total bilirubin of 3.0 mg/dL. Seven patients had MRCP findings of complete narrowing of the CBD. Nine patients had intrahepatic biliary ductal dilation. All nine patients with gadoliniumenhanced MRCP displayed biliary wall thickening with enhancement adjacent to the gallbladder. Nine patients underwent cholecystectomy, one patient underwent percutaneous cholecystostomy. Average bilirubin upon discharge was within normal limits at 0.9 mg/dL after intervention. Two patients had follow-up MRCP showing resolution of biliary narrowing. CONCLUSION A variant of Mirizzi Syndrome occurs in the absence of an offending gallstone in the gallbladder neck or cystic duct to explain the biliary narrowing. We postulate that acute cholecystitis can cause a local inflammatory narrowing resulting in biliary obstruction.
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Affiliation(s)
- Alexander Figacz
- Department of Diagnostic Radiology and Molecular Imaging, Beaumont Health, Royal Oak, MI, USA.
| | - Allan Brazier
- Department of Diagnostic Radiology and Molecular Imaging, Beaumont Health, Royal Oak, MI, USA
| | - Joseph Brazier
- Department of Diagnostic Radiology and Molecular Imaging, Beaumont Health, Royal Oak, MI, USA
| | - Laith H Jamil
- Section of Gastroenterology and Hepatology, Beaumont Health, Royal Oak, MI, USA
| | - Kiran Nandalur
- Department of Diagnostic Radiology and Molecular Imaging, Beaumont Health, Royal Oak, MI, USA
| | - Sayf Al-Katib
- Department of Diagnostic Radiology and Molecular Imaging, Beaumont Health, Royal Oak, MI, USA
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22
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Gupta P, Kalikar V, Patankar R, Patankar A. Laparoscopic management of Mirizzi syndrome with liver cirrhosis using indocyanine green mapping: A case report and review of the literature. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2023. [DOI: 10.18528/ijgii220056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Affiliation(s)
- Priya Gupta
- Department of Gastrointestinal and General Surgery, Zen Multi Speciality Hospital, Chembur, Mumbai, India
| | - Vishakha Kalikar
- Department of Gastrointestinal and General Surgery, Zen Multi Speciality Hospital, Chembur, Mumbai, India
| | - Roy Patankar
- Department of Gastrointestinal and General Surgery, Zen Multi Speciality Hospital, Chembur, Mumbai, India
| | - Advait Patankar
- Department of Gastrointestinal and General Surgery, Zen Multi Speciality Hospital, Chembur, Mumbai, India
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23
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Marinova LA, Leonova AI, Demyatova VA, Gurmikov BN, Zhao AV. [Endoscopic treatment of Mirizzi syndrome]. Khirurgiia (Mosk) 2023:105-110. [PMID: 37186658 DOI: 10.17116/hirurgia2023051105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Mirizzi syndrome is a complication of cholelithiasis occurring in 0.25-6% of cases [1]. Clinical pattern includes jaundice due to prolapse of a large calculus into the common bile duct following cholecystocholedochal fistula. Ultrasound, CT, MRI, MRCP data, as well as some pathognomonic signs provide preoperative diagnostics of Mirizzi syndrome. In most cases, treatment of this syndrome requires open surgery. We report successful endoscopic treatment of a patient with long-standing bile stone disease complicated by Mirizzi syndrome. Postoperative complications of surgery performed in acute period of disease and further staged treatment using retrograde access are illustrated. Endoscopic treatment demonstrated minimally invasive management of disease presenting diagnostic and technical difficulties.
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Affiliation(s)
- L A Marinova
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A I Leonova
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - V A Demyatova
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - B N Gurmikov
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
| | - A V Zhao
- Vishnevsky National Medical Research Center of Surgery, Moscow, Russia
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24
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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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25
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Gulla A, Jasaitė M, Bilotaitė L, Strupas K. Mirizzi Syndrome: Is There a Place for Minimally Invasive Surgery? Visc Med 2022; 38:369-375. [PMID: 36589247 PMCID: PMC9801317 DOI: 10.1159/000525557] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 06/10/2022] [Indexed: 01/04/2023] Open
Abstract
Objectives Mirizzi syndrome (MS) is a condition when an impacted stone in the cystic duct or the Hartmann's pouch due to its extrinsic compression and concomitant inflammation causes an obstruction of the common bile duct. Laparotomy was the preferred surgical technique to treat this syndrome. However, with advances in technologies, an increasing number of surgeons are starting to choose minimally invasive surgery. The objective of this study is to review existing literature relating to minimally invasive surgery treatment of MS. Methods PubMed and ClinicalKey were used to search and identify relevant articles since January 2000 to December 2020. The following keywords were applied: Mirizzi syndrome, laparoscopy, minimally invasive. The criteria for exclusion were applied: case reports with less than 2 patients, nonsurgical treatments, and reviews were excluded from this study. Results Thirty-two articles were identified for analysis, 17 (540 patients in total) of these articles fulfilled the inclusion criteria: 8 retrospective studies, 4 case series, and 5 prospective studies. In the analyzed cohort, 295 patients were treated laparoscopically. Out of 17 articles included in the manuscript, 14 articles provided the information on minimally invasive surgery approach. There were 221 minimally invasive surgeries, out of which 143 (64.7%) were successful, thus according to the type of MS: MS I-175 (79.2%), successful 105 (60%); MS II-40 (18%), successful 32 (80%); MS III-6 (2.7%), successful 6 (100%). The mean conversion rate from laparoscopic to open surgery was 26.2% (range 0-67%), and the median complication rate in seventeen studies was 18.1% (range 0-40%), respectively. The female/male ratio was 1.2:1, and the median age in fifteen studies providing overall data on age was 57.4 years (range 40.1-70.1 years). Conclusions Current evidence presents that open surgery remains the main treatment for MS. Minimally invasive approaches are feasible, safe, and are associated with short-term recovery, significant differences in the operation time and blood loss during operation. However, minimally invasive approaches are mainly restricted to selected patients with type I MS.
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Affiliation(s)
- Aistė Gulla
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Center for Visceral Medicine and Translational Medicine, Institute of Clicinal Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Marta Jasaitė
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Kestutis Strupas
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Center for Visceral Medicine and Translational Medicine, Institute of Clicinal Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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26
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Chuang SH, Kuo KK, Chuang SC, Wang SN, Chang WT, Su WL, Huang JW, Wu PH, Chan HM, Kuok CH. Single-incision versus four-incision laparoscopic transfistulous bile duct exploration for Mirizzi syndrome type II. Surg Endosc 2022; 36:8672-8683. [PMID: 35697855 DOI: 10.1007/s00464-022-09369-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 05/23/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND We developed laparoscopic transfistulous bile duct exploration (LTBDE) for Mirizzi syndrome (MS) McSherry type II in September 2011. Then, single-incision LTBDE (SILTBDE) was adopted as a preferred technique since August 2013. This retrospective study aims to analyze the outcome of LTBDE in 7.7 years and to compare SILTBDE with four-incision LTBDE (4ILTBDE). METHODS Seventeen consecutive patients underwent LTBDE for MS McSherry type II from September 2011 to May 2019. Transfistulous removal of the impacted stone(s), choledochoscopic bile duct exploration, and primary closure of the gallbladder remnant were performed without biliary drainage. RESULTS The sex ratio is 12:5 (male: female) with an average age of 39.4 ± 10.3 (24-56) years. Ten patients (58.8%) had their diagnoses of MS established by preoperative imaging. According to the Csendes classification, three type II (17.6%), nine type III (52.9%), and five type IV (29.4%) were identified. The operative time was 264.8 ± 60.3 min (156-358 min). The stone clearance rate was 100%. The postoperative hospital stay was 4.7 ± 1.9 (2-10) days. No procedure was converted to an open operation. Two postoperative transient hyperamylasemia (11.8%) and one superficial wound infection (5.9%) occurred and all recovered well under conservative treatment (Clavien-Dindo grade I). During an average 2.2-year follow-up period, no biliary stricture or stone recurrence occurred. No significant difference exists between the SILTBDE and 4ILTBDE groups. Nevertheless, an insignificant trend of shorter postoperative hospital stay was observed in the former. A diagnosis of MS Csendes type IV implicates prolonged total and postoperative hospital stays (p < 0.01). CONCLUSIONS LTBDE is safe and efficacious for MS McSherry type II. It provides a simple solution for various types of MS and avoids undesirable complications following bilioenteric anastomosis. SILTBDE is comparable to 4ILTBDE for selected patients. Patients with MS Csendes type IV need more time to recover after surgery.
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Affiliation(s)
- Shu-Hung Chuang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Kung-Kai Kuo
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shih-Chang Chuang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shen-Nien Wang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Tsan Chang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Lung Su
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jian-Wei Huang
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Po-Hsuan Wu
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hon-Man Chan
- Division of General and Digestive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chi-Hang Kuok
- Department of Anesthesiology, Hsinchu MacKay Memorial Hospital, No.690, Sec. 2, Guangfu Road, Hsinchu City, Taiwan.
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Soca Gallego L, Fritz K, Dominguez AJ, Castilla MF. A Case of Gallbladder Adenocarcinoma Presenting as Mirizzi Syndrome in a Non-Jaundiced Patient With Recent Weight Loss. Cureus 2022; 14:e30459. [PMID: 36407138 PMCID: PMC9673054 DOI: 10.7759/cureus.30459] [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] [Accepted: 10/11/2022] [Indexed: 11/07/2022] Open
Abstract
There are many different types of gallbladder diseases, mainly resulting from inflammation. The long-term presence of an insult to the gallbladder leads to chronic inflammation, which is a nidus for complications such as Mirizzi syndrome and gallbladder cancer, both of which can become mimics of one another. Preoperative diagnosis of either gallbladder cancer or Mirizzi syndrome is often difficult, leading to late diagnosis and complicating the patient's treatment course. We report a case of a 65-year-old male who presented with abdominal pain and significant weight loss, with no physical evidence of jaundice and normal liver function. This was initially diagnosed as acute cholecystitis and Mirizzi syndrome before being diagnosed as gallbladder adenocarcinoma on final histology.
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Gómez D, Pedraza M, Cabrera LF, Mendoza Zuchini A, Arrieta G M, Aparicio BS, Pulido J. Minimally invasive management of Mirizzi syndrome Va: Case series and narrative review of the literature. Cir Esp 2022; 100:404-409. [PMID: 35525486 DOI: 10.1016/j.cireng.2022.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/25/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Mirizzi's Syndrome (MS) is a rare pathology, known to be a challenge for the surgeon. In the surgical management, open approach vs laparoscopic is a topic of discussion due to anatomic variations. The aim of this study is to analyze our experience in the laparoscopic management of this condition in Type Va. METHODS We made a descriptive retrospective study of patients diagnosed with MS type Va and treated by laparoscopic approach from 2014 to 2019, in two high volume centers of Bogotá, Colombia. RESULTS 1073 patients who presented complications from gallstones were evaluated, of which 16 were diagnosed with MS type Va. 75% were females and 25% males; 80% presented jaundice and 90% abdominal pain; 12 patients showed cholecystoduodenal fistula and 4 cholecystocolic fistula. All patients underwent laparoscopic management, total cholecystectomy and fistula resection with primary closure was possible on a 100% of the patients. Conversion rate was 0%. The follow up was 18 months. CONCLUSION Laparoscopic management of MS is feasible and safe; the experience of the surgery group and selection of the patients is the key to a successful outcome.
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Affiliation(s)
- Daniel Gómez
- Departamento de Cirugía Laparoscópica Avanzada, Universidad Militar Nueva Granada, Bogotá, Colombia
| | | | | | | | - Manuel Arrieta G
- Cirugía General, Universidad de la Sabana, Chía, Cundinamarca, Colombia
| | | | - Jean Pulido
- Departamento de Medicina, Universidad El Bosque, Bogotá, Colombia
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Jimenez MC, Cubas RF, Bowles RJ, Martinez JM. Type IV Mirizzi Syndrome: Brief Report and Review of Management Options. Am Surg 2022:31348221105182. [PMID: 35623343 DOI: 10.1177/00031348221105182] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Mirizzi syndrome is a rare complication of chronic calculous cholecystitis. Preoperative diagnosis is challenging due to the absence of pathognomonic signs and symptoms and low sensitivity rates of imaging tests. Historically, laparotomy has been the preferred choice of surgical management. Endoscopic and laparoscopic approaches have been increasingly described as diagnostic and therapeutic options for Mirizzi type I and II, but data is limited regarding the management of more complex cases. We describe a staged endoscopic and laparoscopic approach for the management of type IV Mirizzi syndrome and review the management options.
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Affiliation(s)
- M Carolina Jimenez
- Department of Surgery, Division of Laparoendoscopic Surgery, 23214University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Robert F Cubas
- Department of Surgery, Division of Laparoendoscopic Surgery, 23214University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - R Joshua Bowles
- Department of Surgery, Division of Laparoendoscopic Surgery, 23214University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
| | - Jose M Martinez
- Department of Surgery, Division of Laparoendoscopic Surgery, 23214University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, FL, USA
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30
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Podboy A, Gaddam S, Park K, Gupta K, Liu Q, Lo SK. Management of Difficult Choledocholithiasis. Dig Dis Sci 2022; 67:1613-1623. [PMID: 35348969 DOI: 10.1007/s10620-022-07424-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 12/13/2022]
Abstract
Over 30% of all endoscopic retrograde cholangiography procedures in the US are associated with biliary stone extraction, and over 10-15% of these cases are noted to be complex or difficult. The aim of this review is to define the characteristics of difficult common bile duct stones and provide an algorithmic therapeutic approach to these difficult cases. We describe additional special clinical circumstances in which difficult biliary stones are identified and provide additional management strategies to aid endoscopic stone extraction efforts.
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Affiliation(s)
- Alexander Podboy
- Pancreatic and Biliary Disease Program, Department of Digestive Diseases, Cedars Sinai Medical Center, 8700 Beverly Boulevard, South Tower, Suite 7511, Los Angeles, CA, 90048, USA
| | - Srinivas Gaddam
- Pancreatic and Biliary Disease Program, Department of Digestive Diseases, Cedars Sinai Medical Center, 8700 Beverly Boulevard, South Tower, Suite 7511, Los Angeles, CA, 90048, USA
| | - Kenneth Park
- Pancreatic and Biliary Disease Program, Department of Digestive Diseases, Cedars Sinai Medical Center, 8700 Beverly Boulevard, South Tower, Suite 7511, Los Angeles, CA, 90048, USA
| | - Kapil Gupta
- Pancreatic and Biliary Disease Program, Department of Digestive Diseases, Cedars Sinai Medical Center, 8700 Beverly Boulevard, South Tower, Suite 7511, Los Angeles, CA, 90048, USA
| | - Quin Liu
- Pancreatic and Biliary Disease Program, Department of Digestive Diseases, Cedars Sinai Medical Center, 8700 Beverly Boulevard, South Tower, Suite 7511, Los Angeles, CA, 90048, USA
| | - Simon K Lo
- Pancreatic and Biliary Disease Program, Department of Digestive Diseases, Cedars Sinai Medical Center, 8700 Beverly Boulevard, South Tower, Suite 7511, Los Angeles, CA, 90048, USA.
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31
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Khokhar I, Adourian M, Delia E, Mohan G, Mathew M. Mirizzi Syndrome: A Case Report and Review of the Literature. Cureus 2022; 14:e24375. [PMID: 35619848 PMCID: PMC9126480 DOI: 10.7759/cureus.24375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/05/2022] Open
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Varshney VK, Hussain S, Selvakumar B, Vignesh N, Sureka B. Mirizzi Syndrome With Bouveret Syndrome: A Rare Amalgam. Cureus 2022; 14:e24187. [PMID: 35592212 PMCID: PMC9110074 DOI: 10.7759/cureus.24187] [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] [Accepted: 04/16/2022] [Indexed: 11/05/2022] Open
Abstract
Mirizzi and Bouveret syndromes are uncommon but important complications of calculous cholecystitis. Mirizzi syndrome commonly presents with jaundice due to extrinsic compression on the common bile duct by an impacted stone at the gall bladder infundibulum, whereas Bouveret syndrome presents with gastric outlet obstruction due to a large stone in the duodenum. Our case is a 65-year-old lady who presented with pain in the right upper abdomen associated with nausea and vomiting. Contrast-enhanced computed tomography and MRI of the abdomen were suggestive of calculus in the infundibulum of the gall bladder with compression over the common bile duct and a large stone in the first part of the duodenum. Upper gastrointestinal endoscopy confirmed the findings but could not retrieve the stone. Cholecystectomy with the retrieval of calculus from the infundibulum and duodenum was performed with the closure of the fistulous opening. The patient did well in the post-operative period and is doing well after nine months of follow-up. Chronic calculus cholecystitis can present in varied forms, and one should be aware of such rare complications and their management.
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Hsiung T, Lee TS, Lee YL, Huang TS, Wang CY. Recurrent right hepatic artery pseudoaneurysm after robotic-assisted cholecystectomy in a patient with Mirizzi syndrome: a case report. BMC Surg 2022; 22:112. [PMID: 35321717 PMCID: PMC8943984 DOI: 10.1186/s12893-021-01438-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 12/18/2021] [Indexed: 11/23/2022] Open
Abstract
Background Iatrogenic hepatic artery pseudoaneurysm is a rare complication following laparoscopic cholecystectomy. Trans-arterial embolization (TAE) is an effective way to control bleeding after a ruptured aneurysm. But uncommonly, rebleeding may occur which will require a second embolization or even laparotomy. Case presentation We report a case of a 45-year-old woman who underwent robotic-assisted cholecystectomy after the diagnosis of type II Mirizzi syndrome. During the operation, the anterior branch of the right hepatic artery was damaged and Hem-o-lok clips were applied to control the bleeding. The postoperative course was smooth, and the patient was discharged 6 days after the procedure. However, one week after hospital discharge, she presented to the emergency department with right upper abdominal tenderness, melena, and jaundice. After examination, the computed tomography angiography (CTA) revealed a 3 cm pseudoaneurysm at the distal stump of the right hepatic artery anterior branch. TAE with gelfoam material was performed. Three days later, the patient had an acute onset of abdominal pain. A recurrent pseudoaneurysm was found at the same location. She underwent TAE again but this time with a steel coil. No further complication was noted, and she was discharged one week later. Conclusions Even with the assistance of modern technologies such as the robotic surgery system, one should still take extra caution while handling the vessels. Also, embolization of the pseudoaneurysm with steel coils may be suitable for preventing recurrence.
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Affiliation(s)
- Ted Hsiung
- Department of General Surgery, Keelung Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Tsung-Shih Lee
- Division of Hepato-gastroenterology, Keelung Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Yueh-Lin Lee
- Department of Radiology, Keelung Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Ting-Shuo Huang
- Department of General Surgery, Keelung Chang Gung Memorial Hospital, Keelung, 204, Taiwan
| | - Chih-Yuan Wang
- Department of General Surgery, Keelung Chang Gung Memorial Hospital, Keelung, 204, Taiwan.
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Lai W, Yang J, Xu N, Chen JH, Yang C, Yao HH. Surgical strategies for Mirizzi syndrome: A ten-year single center experience. World J Gastrointest Surg 2022; 14:107-119. [PMID: 35317542 PMCID: PMC8908338 DOI: 10.4240/wjgs.v14.i2.107] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/13/2021] [Accepted: 01/14/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mirizzi 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.
AIM To analyze preoperative diagnostic methods and the safety, effectiveness, prognosis and related factors of surgical strategies for different types of MS.
METHODS The 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.
RESULTS Sixty-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).
CONCLUSION MRI/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.
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Affiliation(s)
- Wei Lai
- Department of Hepatobiliary-Pancreatic-Splenic Surgery, Chengdu First People’s Hospital (Chengdu Integrated TCM & Western Medicine Hospital), Chengdu 610044, Sichuan Province, China
| | - Jie Yang
- Department of Hepatobiliary-Pancreatic-Splenic Surgery, Chengdu First People’s Hospital (Chengdu Integrated TCM & Western Medicine Hospital), Chengdu 610044, Sichuan Province, China
| | - Nan Xu
- Department of Hepatobiliary-Pancreatic-Splenic Surgery, Chengdu First People’s Hospital (Chengdu Integrated TCM & Western Medicine Hospital), Chengdu 610044, Sichuan Province, China
| | - Jun-Hua Chen
- Department of Hepatobiliary-Pancreatic-Splenic Surgery, Chengdu First People’s Hospital (Chengdu Integrated TCM & Western Medicine Hospital), Chengdu 610044, Sichuan Province, China
| | - Chen Yang
- Department of Hepatobiliary-Pancreatic-Splenic Surgery, Chengdu First People’s Hospital (Chengdu Integrated TCM & Western Medicine Hospital), Chengdu 610044, Sichuan Province, China
| | - Hui-Hua Yao
- Department of Hepatobiliary-Pancreatic-Splenic Surgery, Chengdu First People’s Hospital (Chengdu Integrated TCM & Western Medicine Hospital), Chengdu 610044, Sichuan Province, China
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35
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Shafiq S, Patil M, Philip M. Mirizzi syndrome: A retrospective analysis of 84 patients from a single center. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2022. [DOI: 10.18528/ijgii210018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Syed Shafiq
- Department of Gastroenterology, St. John’s Medical College Hospital, Bengaluru, India
| | - Mallikarjun Patil
- Department of Gastroenterology, St. John’s Medical College Hospital, Bengaluru, India
| | - Mathew Philip
- Department of Gastroenterology, Lisie Hospital, Kochi, India
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Difficult Biliary Stones: A Comprehensive Review of New and Old Lithotripsy Techniques. Medicina (B Aires) 2022; 58:medicina58010120. [PMID: 35056428 PMCID: PMC8779004 DOI: 10.3390/medicina58010120] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 12/14/2022] Open
Abstract
Biliary stones represent the most common indication for therapeutic endoscopic retrograde cholangiopancreatography. Many cases are successfully managed with biliary sphincterotomy and stone extraction with balloon or basket catheters. However, more complex conditions secondary to the specific features of stones, the biliary tract, or patient’s needs could make the stone extraction with the standard techniques difficult. Traditionally, mechanical lithotripsy with baskets has been reported as a safe and effective technique to achieve stone clearance. More recently, the increasing use of endoscopic papillary large balloon dilation and the diffusion of single-operator cholangioscopy with laser or electrohydraulic lithotripsy have brought new, safe, and effective therapeutic possibilities to the management of such challenging cases. We here summarize the available evidence about the endoscopic management of difficult common bile duct stones and discuss current indications of different lithotripsy techniques.
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37
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Tran A, Hoff C, Polireddy K, Neymotin A, Maddu K. Beyond acute cholecystitis-gallstone-related complications and what the emergency radiologist should know. Emerg Radiol 2021; 29:173-186. [PMID: 34787758 DOI: 10.1007/s10140-021-01999-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/08/2021] [Indexed: 12/30/2022]
Abstract
The purpose of this study is to emphasize the imaging features of complications of gallstones beyond the cystic duct on ultrasound (US), enhanced and nonenhanced computed tomography (CECT and NECT), magnetic resonance imaging (MRI), magnetic resonance cholangiopancreatography (MRCP), and endoscopic retrograde cholangiopancreatography (ERCP). This article includes a brief overview of gallstone imaging and emerging trends in the detection of gallstones. This review article will highlight complications of gallstones, including choledocholithiasis, gallstone pancreatitis, acute cholangitis, Mirizzi syndrome, cholecystobiliary and cholecystoenteric fistulas, and gallstone ileus. Imaging findings and limitations of US, CT, MRI, and ERCP will be discussed. The review article will also briefly discuss the management of each disease. The presence of gallstones beyond the level of the cystic duct can lead to a spectrum of diseases, and emergency radiologists play a critical role in disease management by providing a timely diagnosis. Documenting the location of a gallstone within the common bile duct (CBD) in symptomatic cholelithiasis and the presence of acute interstitial edematous pancreatitis and/or ascending cholangitis plays a pivotal role in disease management. Establishing the presence of ectopic gallstones and biliary-enteric fistulae has a significant role in directing patient management.
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Affiliation(s)
- Andrew Tran
- Emory University School of Medicine, Atlanta, GA, USA.
| | - Carrie Hoff
- Div. Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital Midtown, Atlanta, USA
| | | | - Arie Neymotin
- Department of Radiology, MedStar Health, Washington, DC, USA
| | - Kiran Maddu
- Div. Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital Midtown, Atlanta, USA
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38
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Lee CK, Ramcharan DN, Alaimo KL, Velez V, Risden AE, Klein DH, Garcia O, Joshi V, Jorge JM. Cholecystoduodenal Fistula Evading Imaging and Endoscopic Retrograde Cholangiopancreatography: A Case Report. Cureus 2021; 13:e20049. [PMID: 34987929 PMCID: PMC8717936 DOI: 10.7759/cureus.20049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/05/2022] Open
Abstract
Cholecystoduodenal fistulas are a type of internal biliary fistula that occur due to chronic inflammation of the gallbladder/biliary tree; if left untreated, perforation and necrosis can occur. Cholecystoduodenal fistulas are often difficult to diagnose due to their non-specific signs and symptoms. Since the widespread use of techniques such as magnetic resonance cholangiopancreatography and imaging modalities such as computed tomography, the frequency of reports describing intraoperative cholecystoduodenal fistula has reduced dramatically. Here, we report the case of a 54-year-old female who presented with a two-day history of non-radiating epigastric abdominal pain, initially diagnosed with acute cholecystitis and choledocholithiasis. Upon undergoing laparoscopic cholecystectomy, she was found to have extensive fibrosis of the gallbladder, adhesions, and an impacted gallstone in the wall of the gallbladder. Imaging and endoscopic retrograde cholangiopancreatography performed prior to surgery did not detect a cholecystoduodenal fistula that was discovered intraoperatively. She was treated successfully with laparoscopic cholecystectomy and repair of the duodenum.
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Affiliation(s)
- Charles K Lee
- Medicine, Saint James School of Medicine, Park Ridge, USA
- Surgery, West Suburban Medical Center, Oak Park, USA
| | - Darren N Ramcharan
- Medicine, Saint James School of Medicine, Park Ridge, USA
- Surgery, West Suburban Medical Center, Oak Park, USA
| | - Kayla L Alaimo
- Medicine, Saint James School of Medicine, Park Ridge, USA
- Surgery, West Suburban Medical Center, Oak Park, USA
| | - Veronica Velez
- Surgery, West Suburban Medical Center, Oak Park, USA
- Medicine, Saint James School of Medicine, Park Ridge, USA
| | - Anika E Risden
- Medicine, Saint James School of Medicine, Park Ridge, USA
- Surgery, West Suburban Medical Center, Oak Park, USA
| | - Dhadon H Klein
- Medicine, Saint James School of Medicine, Park Ridge, USA
- Surgery, West Suburban Medical Center, Oak Park, USA
| | - Osbaldo Garcia
- Internal Medicine, Saint James School of Medicine, Park Ridge, USA
- Surgery, West Suburban Medical Center, Oak Park, USA
| | - Vaidehi Joshi
- Medicine, Avalon University School of Medicine, Willemstad, CUW
- Surgery, West Suburban Medical Center, Oak Park, USA
| | - Juaquito M Jorge
- General and Bariatric Surgery, West Suburban Medical Center, Oak Park, USA
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39
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Yang MJ, Park DH. A Stone in Remnant Cystic Duct Causing Mirizzi Syndrome Following Laparoscopic Cholecystectomy. Clin Endosc 2021; 54:777-779. [PMID: 34619834 PMCID: PMC8505174 DOI: 10.5946/ce.2021.205] [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] [Received: 07/19/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Min Jae Yang
- Department of Gastroenterology, Ajou University School of Medicine, Suwon, Korea
| | - Do Hyun Park
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Klekowski J, Piekarska A, Góral M, Kozula M, Chabowski M. The Current Approach to the Diagnosis and Classification of Mirizzi Syndrome. Diagnostics (Basel) 2021; 11:diagnostics11091660. [PMID: 34574001 PMCID: PMC8465817 DOI: 10.3390/diagnostics11091660] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/30/2021] [Accepted: 09/07/2021] [Indexed: 12/24/2022] Open
Abstract
Mirizzi syndrome occurs in up to 6% of patients with cholecystolithiasis. It is generally caused by external compression of the common hepatic duct by a gallstone impacted in the neck of the gallbladder or the cystic duct, which can lead to fistulisation. The aim of this review was to highlight the proposed classifications for Mirizzi syndrome (MS) and to provide an update on modern approaches to the diagnosis of this disease. We conducted research on various internet databases and the total number of records was 993, but after a gradual process of elimination our final review consisted of 21 articles. According to the literature, the Cesendes classification is the most commonly used, but many new suggestions have appeared. Our review shows that the ultrasonography (US) is the most frequently used method of initial diagnosis, despite still having only average sensitivity. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) are good methods and are similarly effective, but only the latter can be simultaneously therapeutic. Some modern methods show very high sensitivity, but are not so commonly administered. Mirizzi syndrome is still a diagnostic challenge, despite the advancement of the available tools. Preoperative diagnosis is crucial to avoid complications during treatment. New research may bring a unification of classifications and diagnostic algorithms.
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Affiliation(s)
- Jakub Klekowski
- Student Research Group No 180, Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.K.); (A.P.); (M.G.); (M.K.)
| | - Aleksandra Piekarska
- Student Research Group No 180, Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.K.); (A.P.); (M.G.); (M.K.)
| | - Marta Góral
- Student Research Group No 180, Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.K.); (A.P.); (M.G.); (M.K.)
| | - Marta Kozula
- Student Research Group No 180, Faculty of Medicine, Wroclaw Medical University, 50-367 Wrocław, Poland; (J.K.); (A.P.); (M.G.); (M.K.)
| | - Mariusz Chabowski
- Division of Oncology and Palliative Care, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618 Wrocław, Poland
- Department of Surgery, 4th Military Teaching Hospital, 5 Weigla Street, 50-981 Wrocław, Poland
- Correspondence: ; Tel.: +48-261-660-247; Fax: +48-261-660-245
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Rodrigues T, Boike JR. Biliary Strictures: Etiologies and Medical Management. Semin Intervent Radiol 2021; 38:255-262. [PMID: 34393335 DOI: 10.1055/s-0041-1731086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Biliary strictures have several etiologies that can broadly be classified into benign and malignant causes. The clinical presentation is variable with strictures identified incidentally on imaging or during the evaluation of routine laboratory abnormalities. Symptoms and cholangitis lead to imaging that can diagnose biliary strictures. The diagnosis and medical management of biliary strictures will be discussed in this article.
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Affiliation(s)
- Terrance Rodrigues
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Justin R Boike
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Yeh CN, Wang SY, Liu KH, Yeh TS, Tsai CY, Tseng JH, Wu CH, Liu NJ, Chu YY, Jan YY. Surgical outcome of Mirizzi syndrome: Value of endoscopic retrograde cholangiopancreatography and laparoscopic procedures. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:760-769. [PMID: 34174017 DOI: 10.1002/jhbp.1016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 06/04/2021] [Accepted: 06/15/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic cholecystectomy (LC) with associated procedures and endoscopic retrograde cholangiopancreatography (ERCP) have been the standard treatments for both common and rare biliary diseases. Mirizzi syndrome (MS) is a rare and complex biliary condition. We report our experience with MS treatment and investigate the value of laparoscopic procedures and ERCP in patient management. METHODS From 2004 to 2017, 100 consecutive patients with MS were diagnosed by ERCP and underwent surgery in a referral center. Sixty patients were treated with intended LC, and 40 patients were treated with open cholecystectomy (OC). The clinical manifestations, ERCP and associated procedures, surgical procedures, and postoperative outcomes were investigated. RESULTS The surgical mortality rate was 1%, while the surgical morbidity rate was 15%. The patients treated with intended LC suffered from less morbidity (5%). The percentage of postoperative residual biliary stones was 32% (n = 32), and only three patients underwent re-operation (laparotomy) for stone removal. The laparotomy conversion rate in the intended LC group was 16.7% (10/60). The length of hospitalization for the patients with successful LC was significantly shorter than that for the patients with conversion and intended OC. Csendes classification was a risk factor for conversion from LC to OC (type I vs types II to V, P < .0001). CONCLUSIONS A combination of a laparoscopic procedure and ERCP may provide therapeutic benefits for patients with MS.
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Affiliation(s)
- Chun-Nan Yeh
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Shang-Yu Wang
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Keng-Hao Liu
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Ta-Sen Yeh
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Yi Tsai
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Jeng-Hwei Tseng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Chi-Huan Wu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Nai-Jen Liu
- Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Yin-Yi Chu
- Department of Gastroenterology and Hepatology, New Taipei Municipal Tu-Cheng Hospital (Built and Operated by Chang Gung, Medical Foundation), New Taipei City, Taiwan
| | - Yi-Yin Jan
- Department of General Surgery, Chang Gung Memorial Hospital, Linkou, Chang Gung University, Taoyuan, Taiwan
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43
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Rizzo GEM, Rizzo G, Di Carlo G, Corbo G, Ferro G, Sciumè C. Mirizzi syndrome type V complicated with both cholecystobiliary and cholecystocolic fistula: a case report. J Surg Case Rep 2021; 2021:rjab239. [PMID: 34194723 PMCID: PMC8238397 DOI: 10.1093/jscr/rjab239] [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: 03/23/2021] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
Mirizzi syndrome (MS) is a common bile duct (CBD) obstruction caused by extrinsic compression from an impacted stone in the cystic duct or infundibulum of the gallbladder. Patients affected by MS may present abdominal pain and jaundice. A 37-year-old male with neurologic residuals post-encephalitis arrived at the emergency department reporting abdominal pain, jaundice and fever. An ultrasound of the abdomen identified cholecystolithiasis with a dilated CBD. He did not undergo CT or MRI due to poor compliance and parents’ disagreement. Eventually, they accepted to perform endoscopic retrograde cholangiopancreatography, which diagnosed MS with both cholecystobiliary and cholecystocolonic fistula without gallstone ileum (type Va). Therefore, patient underwent cholecystectomy, wedge resection of the colon and choledochoplasty with ‘Kehr's T-tube’ insertion. A plastic biliary stent was successively placed and removed after 4 month. Ultimately, he did neither complain any other biliary symptoms nor alteration in laboratory tests after 4-years of follow-up.
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Affiliation(s)
- Giacomo E M Rizzo
- Section of Gastroenterology and Hepatology, Department of Health Promotion Sciences Maternal and Infant Care, Internal Medicine and Medical Specialties, PROMISE, University of Palermo, Palermo, Italy.,Section of Endoscopy, Department of General Surgery, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Giovanna Rizzo
- Section of Endoscopy, Department of General Surgery, San Giovanni di Dio Hospital, Agrigento, Italy.,Department of Surgical, Oncological and Oral Science, Palermo University Hospital, Palermo, Italy
| | - Giovanni Di Carlo
- Section of Endoscopy, Department of General Surgery, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Giovanni Corbo
- Section of Endoscopy, Department of General Surgery, San Giovanni di Dio Hospital, Agrigento, Italy.,Department of Surgical, Oncological and Oral Science, Palermo University Hospital, Palermo, Italy
| | - Giuseppina Ferro
- Section of Endoscopy, Department of General Surgery, San Giovanni di Dio Hospital, Agrigento, Italy
| | - Carmelo Sciumè
- Section of Endoscopy, Department of General Surgery, San Giovanni di Dio Hospital, Agrigento, Italy.,Department of Surgical, Oncological and Oral Science, Palermo University Hospital, Palermo, Italy
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de'Angelis N, Catena F, Memeo R, Coccolini F, Martínez-Pérez A, Romeo OM, De Simone B, Di Saverio S, Brustia R, Rhaiem R, Piardi T, Conticchio M, Marchegiani F, Beghdadi N, Abu-Zidan FM, Alikhanov R, Allard MA, Allievi N, Amaddeo G, Ansaloni L, Andersson R, Andolfi E, Azfar M, Bala M, Benkabbou A, Ben-Ishay O, Bianchi G, Biffl WL, Brunetti F, Carra MC, Casanova D, Celentano V, Ceresoli M, Chiara O, Cimbanassi S, Bini R, Coimbra R, Luigi de'Angelis G, Decembrino F, De Palma A, de Reuver PR, Domingo C, Cotsoglou C, Ferrero A, Fraga GP, Gaiani F, Gheza F, Gurrado A, Harrison E, Henriquez A, Hofmeyr S, Iadarola R, Kashuk JL, Kianmanesh R, Kirkpatrick AW, Kluger Y, Landi F, Langella S, Lapointe R, Le Roy B, Luciani A, Machado F, Maggi U, Maier RV, Mefire AC, Hiramatsu K, Ordoñez C, Patrizi F, Planells M, Peitzman AB, Pekolj J, Perdigao F, Pereira BM, Pessaux P, Pisano M, Puyana JC, Rizoli S, Portigliotti L, Romito R, Sakakushev B, Sanei B, Scatton O, Serradilla-Martin M, Schneck AS, Sissoko ML, Sobhani I, Ten Broek RP, Testini M, Valinas R, Veloudis G, Vitali GC, Weber D, Zorcolo L, Giuliante F, Gavriilidis P, Fuks D, Sommacale D. 2020 WSES guidelines for the detection and management of bile duct injury during cholecystectomy. World J Emerg Surg 2021; 16:30. [PMID: 34112197 PMCID: PMC8190978 DOI: 10.1186/s13017-021-00369-w] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 05/18/2021] [Indexed: 12/16/2022] Open
Abstract
Bile duct injury (BDI) is a dangerous complication of cholecystectomy, with significant postoperative sequelae for the patient in terms of morbidity, mortality, and long-term quality of life. BDIs have an estimated incidence of 0.4-1.5%, but considering the number of cholecystectomies performed worldwide, mostly by laparoscopy, surgeons must be prepared to manage this surgical challenge. Most BDIs are recognized either during the procedure or in the immediate postoperative period. However, some BDIs may be discovered later during the postoperative period, and this may translate to delayed or inappropriate treatments. Providing a specific diagnosis and a precise description of the BDI will expedite the decision-making process and increase the chance of treatment success. Subsequently, the choice and timing of the appropriate reconstructive strategy have a critical role in long-term prognosis. Currently, a wide spectrum of multidisciplinary interventions with different degrees of invasiveness is indicated for BDI management. These World Society of Emergency Surgery (WSES) guidelines have been produced following an exhaustive review of the current literature and an international expert panel discussion with the aim of providing evidence-based recommendations to facilitate and standardize the detection and management of BDIs during cholecystectomy. In particular, the 2020 WSES guidelines cover the following key aspects: (1) strategies to minimize the risk of BDI during cholecystectomy; (2) BDI rates in general surgery units and review of surgical practice; (3) how to classify, stage, and report BDI once detected; (4) how to manage an intraoperatively detected BDI; (5) indications for antibiotic treatment; (6) indications for clinical, biochemical, and imaging investigations for suspected BDI; and (7) how to manage a postoperatively detected BDI.
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Affiliation(s)
- Nicola de'Angelis
- Unit of Minimally Invasive and Robotic Digestive Surgery, General Regional Hospital "F. Miulli", Strada Prov. 127 Acquaviva - Santeramo Km. 4, 70021 Acquaviva delle Fonti BA, Bari, Italy. .,Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France.
| | - Fausto Catena
- Department of Emergency and Trauma Surgery of the University Hospital of Parma, Parma, Italy
| | - Riccardo Memeo
- Department of Hepato-Pancreatic-Biliary Surgery, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Federico Coccolini
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Aleix Martínez-Pérez
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Oreste M Romeo
- Trauma, Burn, and Surgical Care Program, Bronson Methodist Hospital, Kalamazoo, Michigan, USA
| | - Belinda De Simone
- Service de Chirurgie Générale, Digestive, et Métabolique, Centre hospitalier de Poissy/Saint Germain en Laye, Saint Germain en Laye, France
| | - Salomone Di Saverio
- Department of Surgery, Cambridge University Hospital, NHS Foundation Trust, Cambridge, UK
| | - Raffaele Brustia
- Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Rami Rhaiem
- Department of HBP and Digestive Oncologic Surgery, Robert Debré University Hospital, Reims, France
| | - Tullio Piardi
- Department of HBP and Digestive Oncologic Surgery, Robert Debré University Hospital, Reims, France.,Department of Surgery, HPB Unit, Troyes Hospital, Troyes, France
| | - Maria Conticchio
- Department of Hepato-Pancreatic-Biliary Surgery, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Francesco Marchegiani
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Nassiba Beghdadi
- Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates
| | - Ruslan Alikhanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Shosse Enthusiastov, 86, 111123, Moscow, Russia
| | | | - Niccolò Allievi
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Giuliana Amaddeo
- Service d'Hepatologie, APHP, Henri Mondor University Hospital, Creteil, and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Luca Ansaloni
- General Surgery, San Matteo University Hospital, Pavia, Italy
| | | | - Enrico Andolfi
- Department of Surgery, Division of General Surgery, San Donato Hospital, 52100, Arezzo, Italy
| | - Mohammad Azfar
- Department of Surgery, Al Rahba Hospital, Abu Dhabi, UAE
| | - Miklosh Bala
- Trauma and Acute Care Surgery Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Amine Benkabbou
- Surgical Oncology Department, National Institute of Oncology, Mohammed V University in Rabat, Rabat, Morocco
| | - Offir Ben-Ishay
- Department of General Surgery, Rambam Healthcare Campus, Haifa, Israel
| | - Giorgio Bianchi
- Unit of Minimally Invasive and Robotic Digestive Surgery, General Regional Hospital "F. Miulli", Strada Prov. 127 Acquaviva - Santeramo Km. 4, 70021 Acquaviva delle Fonti BA, Bari, Italy
| | - Walter L Biffl
- Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, California, USA
| | - Francesco Brunetti
- Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | | | - Daniel Casanova
- Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | - Valerio Celentano
- Colorectal Unit, Chelsea and Westminster Hospital, NHS Foundation Trust, London, UK
| | - Marco Ceresoli
- Emergency and General Surgery Department, University of Milan Bicocca, Milan, Italy
| | - Osvaldo Chiara
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Stefania Cimbanassi
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Roberto Bini
- General Surgery and Trauma Team, ASST Niguarda Milano, University of Milano, Milan, Italy
| | - Raul Coimbra
- Riverside University Health System Medical Center, Comparative Effectiveness and Clinical Outcomes Research Center - CECORC and Loma Linda University School of Medicine, Loma Linda, USA
| | - Gian Luigi de'Angelis
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Decembrino
- Gastroenterology and Endoscopy Unit, General Regional Hospital "F. Miulli", Acquaviva delle Fonti, Bari, Italy
| | - Andrea De Palma
- General, Emergency and Trauma Department, Pisa University Hospital, Pisa, Italy
| | - Philip R de Reuver
- Department of Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Carlos Domingo
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | | | - Alessandro Ferrero
- Department of General and Oncological Surgery, Azienda Ospedaliera Ordine Mauriziano "Umberto I", Turin, Italy
| | - Gustavo P Fraga
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Federica Gaiani
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Federico Gheza
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Angela Gurrado
- Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Ewen Harrison
- Department of Clinical Surgery and Centre for Medical Informatics, Usher Institute, University of Edinburgh, Little France Crescent, Edinburgh, UK
| | | | - Stefan Hofmeyr
- Division of Surgery, Surgical Gastroenterology Unit, Tygerberg Academic Hospital, University of Stellenbosch Faculty of Medicine and Health Sciences, Stellenbosch, South Africa
| | - Roberta Iadarola
- Department of Emergency and Trauma Surgery of the University Hospital of Parma, Parma, Italy
| | - Jeffry L Kashuk
- Department of Surgery, Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
| | - Reza Kianmanesh
- Department of HBP and Digestive Oncologic Surgery, Robert Debré University Hospital, Reims, France
| | - Andrew W Kirkpatrick
- Department of Surgery, Critical Care Medicine and the Regional Trauma Service, Foothills Medical Center, Calgari, Alberta, Canada
| | - Yoram Kluger
- Department of General Surgery, Rambam Healthcare Campus, Haifa, Israel
| | - Filippo Landi
- Department of HPB and Transplant Surgery, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
| | - Serena Langella
- Department of General and Oncological Surgery, Azienda Ospedaliera Ordine Mauriziano "Umberto I", Turin, Italy
| | - Real Lapointe
- Department of HBP Surgery and Liver Transplantation, Department of Surgery, Centre Hospitalier de l'Université de Montreal, Montreal, QC, Canada
| | - Bertrand Le Roy
- Department of Digestive Surgery, University Hospital of Saint-Etienne, Saint-Priest-en-Jarez, France
| | - Alain Luciani
- Unit of Radiology, Henri Mondor University Hospital (AP-HP), Creteil, and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Fernando Machado
- Department of Emergency Surgery, Hospital de Clínicas, School of Medicine UDELAR, Montevideo, Uruguay
| | - Umberto Maggi
- General Surgery and Liver Transplantation Unit, Fondazione IRCCS Ca'Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Ronald V Maier
- Department of Surgery, University of Washington, Seattle, WA, USA
| | - Alain Chichom Mefire
- Department of Surgery and Obstetrics/Gynecologic, Regional Hospital, Limbe, Cameroon
| | - Kazuhiro Hiramatsu
- Department of General Surgery, Toyohashi Municipal Hospital, Toyohashi, Aichi, Japan
| | - Carlos Ordoñez
- Division of Trauma and Acute Care Surgery, Department of Surgery, Fundacion Valle del Lili, Universidad del Valle Cali, Cali, Colombia
| | - Franca Patrizi
- Unit of Gastroenterology and Endoscopy, Maggiore Hospital, Bologna, Italy
| | - Manuel Planells
- Department of General and Digestive Surgery, Hospital Universitario Doctor Peset, Valencia, Spain
| | - Andrew B Peitzman
- Department of Surgery, UPMC, University of Pittsburg, School of Medicine, Pittsburg, USA
| | - Juan Pekolj
- General Surgery, Liver Transplant Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Fabiano Perdigao
- Liver Transplant Unit, APHP, Unité de Chirurgie Hépatobiliaire et Transplantation hépatique, Hôpital Pitié Salpêtrière, Paris, France
| | - Bruno M Pereira
- Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil
| | - Patrick Pessaux
- Hepatobiliary and Pancreatic Surgical Unit, Visceral and Digestive Surgery, IHU mix-surg, Institute for Minimally Invasive Image-Guided Surgery, University of Strasbourg, Strasbourg, France
| | - Michele Pisano
- 1st Surgical Unit, Department of Emergency, Papa Giovanni Hospital XXIII, Bergamo, Italy
| | - Juan Carlos Puyana
- Trauma & Acute Care Surgery - Global Health, University of Pittsburgh, Pittsburgh, USA
| | - Sandro Rizoli
- Trauma and Acute Care Service, St Michael's Hospital, Toronto, ON, Canada
| | - Luca Portigliotti
- Chirurgia Epato-Gastro-Pancreatica, Azienda Ospedaliera-Universitaria Maggiore della Carità, Novara, Italy
| | - Raffaele Romito
- Chirurgia Epato-Gastro-Pancreatica, Azienda Ospedaliera-Universitaria Maggiore della Carità, Novara, Italy
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Behnam Sanei
- Department of Surgery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Olivier Scatton
- Liver Transplant Unit, APHP, Unité de Chirurgie Hépatobiliaire et Transplantation hépatique, Hôpital Pitié Salpêtrière, Paris, France
| | - Mario Serradilla-Martin
- Instituto de Investigación Sanitaria Aragón, Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Anne-Sophie Schneck
- Digestive Surgery Unit, Centre Hospitalier Universitaire de Guadeloupe, Pointe-À-Pitre, Les Avymes, Guadeloupe, France
| | - Mohammed Lamine Sissoko
- Service de Chirurgie, Hôpital National Blaise Compaoré de Ouagadougou, Ouagadougou, Burkina Faso
| | - Iradj Sobhani
- Department of Gastroenterology and Digestive Endoscopy, Henri Mondor Hospital, AP-HP, Creteil, and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
| | - Richard P Ten Broek
- Department of Surgery, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Mario Testini
- Unit of General Surgery "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University of Bari "Aldo Moro", Bari, Italy
| | - Roberto Valinas
- Department of Surgery "F", Faculty of Medicine, Clinic Hospital "Dr. Manuel Quintela", Montevideo, Uruguay
| | | | - Giulio Cesare Vitali
- Division of Transplantation, Department of Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Dieter Weber
- Department of Trauma Surgery, Royal Perth Hospital, Perth, Australia
| | - Luigi Zorcolo
- Department of Surgery, Colorectal Surgery Unit, University of Cagliari, Cagliari, Italy
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Foundation "Policlinico Universitario A. Gemelli", IRCCS, Rome, Italy
| | - Paschalis Gavriilidis
- Division of Gastrointestinal and HBP Surgery, Imperial College HealthCare, NHS Trust, Hammersmith Hospital, London, UK
| | - David Fuks
- Institut Mutualiste Montsouris, Paris, France
| | - Daniele Sommacale
- Unit of Digestive, Hepatobiliary and Pancreatic Surgery, CARE Department, Henri Mondor University Hospital (AP-HP), and Faculty of Medicine, University of Paris Est, UPEC, Creteil, France
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Gómez D, Pedraza M, Cabrera LF, Mendoza Zuchini A, Arrieta G M, Aparicio BS, Pulido J. Minimally invasive management of Mirizzi syndrome Va: Case series and narrative review of the literature. Cir Esp 2021; 100:S0009-739X(21)00169-X. [PMID: 34082891 DOI: 10.1016/j.ciresp.2021.04.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Mirizzi's Syndrome (MS) is a rare pathology, known to be a challenge for the surgeon. In the surgical management, open approach vs laparoscopic is a topic of discussion due to anatomic variations. The aim of this study is to analyze our experience in the laparoscopic management of this condition in Type Va. METHODS We made a descriptive retrospective study of patients diagnosed with MS type Va and treated by laparoscopic approach from 2014 to 2019, in two high volume centers of Bogotá, Colombia. RESULTS 1073 patients who presented complications from gallstones were evaluated, of which 16 were diagnosed with MS type Va. 75% were females and 25% males; 80% presented jaundice and 90% abdominal pain; 12 patients showed cholecystoduodenal fistula and 4 cholecystocolic fistula. All patients underwent laparoscopic management, total cholecystectomy and fistula resection with primary closure was possible on a 100% of the patients. Conversion rate was 0%. The follow up was 18 months. CONCLUSION Laparoscopic management of MS is feasible and safe; the experience of the surgery group and selection of the patients is the key to a successful outcome.
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Affiliation(s)
- Daniel Gómez
- Departamento de Cirugía Laparoscópica Avanzada, Universidad Militar Nueva Granada, Bogotá, Colombia
| | | | | | | | - Manuel Arrieta G
- Cirugía General, Universidad de la Sabana, Chía, Cundinamarca, Colombia
| | | | - Jean Pulido
- Departamento de Medicina, Universidad El Bosque, Bogotá. Colombia
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Vanetta C, Paladini JI, Di Menno J, Goransky J, Palavecino M, Arbues G, De Santibañes M, Sánchez-Claria R, Mazza O, Ardiles V, Pekolj J. Role of laparoscopy in the treatment of internal biliary fistulas in a high-volume center and a review of the literature. Surg Endosc 2021; 36:1799-1805. [PMID: 33791855 DOI: 10.1007/s00464-021-08459-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/17/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Biliary fistulas may result as a complication of gallstone disease. According to their tract, abdominal internal biliary fistulas may be classified into cholecystobiliary and bilioenteric fistulas. Surgical treatment is challenging and requires highly trained surgeons with high preoperative suspicion. Conventional surgery is still of choice by most of the authors. However, laparoscopy is emerging as a minimally invasive alternative. We investigated the surgical approach, conversion rate, and outcomes according to the type of biliary fistula. METHODS We retrospectively reviewed 11,130 laparoscopic cholecystectomies, 31 open cholecystectomies, and 31 surgeries for gallstone ileus at our institution from May 2007 to May 2020. We diagnosed internal biliary fistula in 73 patients and divided them into two groups according to their fistulous tract: cholecystobiliary fistula and bilioenteric fistula. We described demographic characteristics, preoperative imaging modalities, surgical approach, conversion rates, surgical procedures, and outcomes. We additionally revised the literature and compared our results with 13 studies from the past 10 years. RESULTS There were 22 and 51 patients in the cholecystobiliary and bilioenteric groups, respectively. Our preoperative suspicion of a fistula was 80%. We started 88% of procedures by laparoscopic approach. The effectiveness of laparoscopy in the resolution of internal biliary fistula was 40% for cholecystobiliary fistula and 55% for bilioenteric fistulas. The most frequent cause for conversion to laparotomy was the difficulty to identify anatomical features, in addition to the need to perform a Roux en-Y hepaticojejunostomy. Choledocholithiasis was not associated with an increase in conversion rates. CONCLUSIONS Laparoscopic resolution of a biliary fistula is still a matter of controversy. Despite the high conversion rates, we believe that a great number of patients benefit from this minimally invasive technique. A high preoperative suspicion and trained surgeons are vital in the treatment of internal biliary fistulas.
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Affiliation(s)
- Carolina Vanetta
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABH, Buenos Aires, Argentina. .,Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1181ACH, Buenos Aires, Argentina.
| | - José Ignacio Paladini
- Section of Hepato-Biliary-Pancreatic Surgery, Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
| | - Juliana Di Menno
- Section of Hepato-Biliary-Pancreatic Surgery, Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
| | - Jeremias Goransky
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABH, Buenos Aires, Argentina.,Section of Hepato-Biliary-Pancreatic Surgery, Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
| | - Martin Palavecino
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABH, Buenos Aires, Argentina.,Section of Hepato-Biliary-Pancreatic Surgery, Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
| | - Guillermo Arbues
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABH, Buenos Aires, Argentina.,Section of Hepato-Biliary-Pancreatic Surgery, Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
| | - Martín De Santibañes
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABH, Buenos Aires, Argentina.,Section of Hepato-Biliary-Pancreatic Surgery, Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
| | - Rodrigo Sánchez-Claria
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABH, Buenos Aires, Argentina.,Section of Hepato-Biliary-Pancreatic Surgery, Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
| | - Oscar Mazza
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABH, Buenos Aires, Argentina.,Section of Hepato-Biliary-Pancreatic Surgery, Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
| | - Victoria Ardiles
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABH, Buenos Aires, Argentina.,Section of Hepato-Biliary-Pancreatic Surgery, Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
| | - Juan Pekolj
- Department of General Surgery, Hospital Italiano de Buenos Aires, Juan D. Perón 4190, C1199ABH, Buenos Aires, Argentina.,Section of Hepato-Biliary-Pancreatic Surgery, Department of General Surgery, Hospital Italiano of Buenos Aires, Buenos Aires, Argentina
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Sadovnikov I, Anthony M, Mushtaq R, Khreiss M, Gavini H, Arif-Tiwari H. Role of magnetic resonance imaging in Bouveret's syndrome: A case report with review of the literature. Clin Imaging 2021; 77:43-47. [PMID: 33640790 DOI: 10.1016/j.clinimag.2021.02.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 12/15/2020] [Accepted: 02/21/2021] [Indexed: 12/22/2022]
Abstract
Bouveret's syndrome is a rare form of gallstone ileus occurring due to obstructing gallstone into the proximal duodenum through a cholecystoduodenal fistula. We report the case of a 72-year-old female presenting with abdominal pain secondary to a large gallstone in the region of the duodenal bulb, causing the upstream gastric obstruction. Here we discuss the clinical features, imaging technologies, and surgical management of Bouveret's syndrome.
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Affiliation(s)
- Irina Sadovnikov
- Department of Medical Imaging, University of Arizona, Tucson, AZ, USA.
| | | | - Raza Mushtaq
- Department of Medical Imaging, University of Arizona, Tucson, AZ, USA
| | | | - Hemanth Gavini
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Hina Arif-Tiwari
- Department of Medical Imaging, University of Arizona, Tucson, AZ, USA
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48
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Gallstone lithotripsy with SpyGlass™ system through a cholecystoduodenal fistula in a patient with type IIIa Mirizzi syndrome. REVISTA DE GASTROENTEROLOGÍA DE MÉXICO 2021. [DOI: 10.1016/j.rgmxen.2020.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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49
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Gonzalez-Urquijo M, Gil-Galindo G, Rodarte-Shade M. Mirizzi syndrome from type I to Vb: a single center experience. Turk J Surg 2020; 36:399-404. [PMID: 33778400 PMCID: PMC7963310 DOI: 10.47717/turkjsurg.2020.4676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Accepted: 01/29/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The present study describes a cohort of patients diagnosed with Mirizzi syndrome from type I to Vb, over a period of four years. It aimed to identify diagnostic and management pitfalls of Mirizzi syndrome, as well as their concomitant cholecystobiliary or cholecystoenteric fistulas. MATERIAL AND METHODS We retrospectively reviewed all electronic medical records of patients who underwent surgery for Mirizzi syndrome at a single institution. RESULTS Twenty-two patients (0.6%) were diagnosed with Mirizzi syndrome. Most of the patients were females (n=19, 86.3%). Mean age was 43.8 years (range: 21-71 years). Ultrasound was performed in all (100%) patients. Six (27.2%) patients had a CT scan and six (27.2%) patients had endoscopic retrograde cholangiopancreatography. Overall preoperative diagnosis was achieved on 36.6% (n=8) of the patients. There were the same total and partial cholecystectomies, accounting for ten (45.5%) cases each, one hepaticojejunostomy with cholecystectomy (4.5%), and one enterolithotomy (4.5%). Laparoscopic cholecystectomy was attempted in 15 (68.1%) patients, with conversion to open surgery in 93.3% (n=14) of the patients. An open approach was made in five (22.7%) cases. Four (18.1%) patients were reported as MS type I, both types II and III each account for 22.7% (n=5) of the cases, there was only one (4.5%) patient with type IV, and seven (31.8%) patients with type V. CONCLUSION There are limited studies of patients with Mirizzi syndrome, including type V classification, and when this syndrome is suspected, a preoperative diagnosis should be made to avoid bile duct injuries or lesions to adjacent organs.
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Affiliation(s)
- Mauricio Gonzalez-Urquijo
- Department of Surgery, Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico
| | | | - Mario Rodarte-Shade
- Department of Surgery, Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, Mexico
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50
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Corion CL, Vriens PW, Alwayn IP, Hamming JF, van Schaik J. Giant true hepatic aneurysm mimicking Mirizzi syndrome. J Vasc Surg Cases Innov Tech 2020; 6:633-636. [PMID: 33163749 PMCID: PMC7599373 DOI: 10.1016/j.jvscit.2020.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/18/2020] [Indexed: 11/13/2022] Open
Abstract
Giant true aneurysms of the hepatic arteries are rare. Pseudoaneurysms of the hepatic arteries are more common and are mostly caused by intra-abdominal infection, iatrogenic injury, or trauma. Hepatic or cystic pseudoaneurysms are often successfully treated by embolization owing to their saccular nature as opposed to true aneurysms. We present a case of a patient with a giant true aneurysm of the proper hepatic artery, mimicking Mirizzi syndrome. Open reconstruction was successfully preformed, and the patient made a full recovery.
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Affiliation(s)
| | | | - Ian P.J. Alwayn
- Department of Surgery, Leiden University Medical Center, Leiden
| | - Jaap F. Hamming
- Department of Surgery, Leiden University Medical Center, Leiden
| | - Jan van Schaik
- Department of Surgery, Leiden University Medical Center, Leiden
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