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. 2006;8(6):474-9.
doi: 10.1080/13651820600840082.

Mirizzi's syndrome--results from a large western experience

D Gomez  1 , S H Rahman, G J Toogood, K R Prasad, J P A Lodge, P J Guillou, K V Menon
Affiliations

Mirizzi's syndrome--results from a large western experience

D Gomez et al. HPB (Oxford). 2006.

Abstract

Background: This paper reports a series of patients with Mirizzi's syndrome (MS) who were managed at our institution over an 11-year (1994-2005) period.

Methods: Retrospective case note study of patients with a definitive or possible diagnosis of MS stated in radiology reports were identified using the hospital's radiology computer coding system.

Results: 33 patients were identified with a median age of diagnosis of 70 (35-90) years and male to female ratio of 15:18. Liver function tests were deranged in all patients. Pre-operative radiological diagnosis was achieved in 28 patients: ultrasound scan (n = 4), computer tomography (n = 3), magnetic resonance cholangiopancreatography (n = 10) and endoscopic retrograde cholangiopancreatography (n = 11). Five patients were diagnosed intra-operatively. Type I MS was reported in 27 patients. Laparoscopic cholecystectomy was attempted in 18 patients with 6 being converted to open cholecystectomy. Six patients had biliary stent insertion only and 3 were conservatively managed. Six patients had type II MS, 4 were treated with open cholecystectomy and Roux-en-Y hepaticojejunostomy, 1 underwent an open subtotal cholecystectomy with fistula closure and 1 had percutaneous biliary stent insertion only. The median follow-up period was 2 (1-7) months (n = 18). 10 patients are currently under follow-up. Overall morbidity was 27% (n = 8) and mortality was 7% (n = 2).

Conclusion: Pre-operative diagnosis of MS can be achieved using MRCP. Laparoscopic cholecystectomy for type I MS is a safe option and type II MS can be treated with Roux-en-Y hepaticojejunostomy or subtotal cholecystectomy with fistula closure.

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Figures

Figure 1.
Figure 1.
Magnetic resonance cholangiopancreatography demonstrating type I Mirizzi's syndrome.
Figure 2.
Figure 2.
Imaging performed on patients in our study.
Figure 3.
Figure 3.
Management of patients with Mirizzi's syndrome based on the McSherry et al. classification in this study.
See this image and copyright information in PMC

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