Mirizzi's syndrome

As Mirizzi syndrome is a rare form of obstructive jaundice, so the jaundice is referred to as a result of relocation of the biliary tract. It occurs when the common hepatic duct is compressed by a calculus in the neck of the gall bladder or in the cystic duct. Only about one in a thousand patients with gallstone disease has a Mirizzi syndrome. A long shared history of common hepatic duct and the cystic duct with a deep junction favors this suffering. It was described in 1948 by Pablo L. Mirizzi, but had been known since 1905.

Symptoms

The symptoms are similar to a common duct stone: upper abdominal pain, nausea, colic, increasing jaundice, acholischer chair, beer brown urine and steatorrhea. Symptoms of cholecystitis are not uncommon.

Diagnosis

The cholestasis ( alkaline phosphatase, bilirubin, etc.) are greatly increased. To determine the position of the calculus an upper abdominal ultrasonography or ERCP is necessary. Differential diagnosis includes other mechanical blockage of the bile outflow must be excluded: tumors, strictures, in Third World countries such as the roundworm parasites. The location of the stone is atypical when Mirizzi syndrome for obstructive jaundice.

Therapy

The gallbladder must be removed and a possible choledocholithiasis are either preoperatively or intraoperatively removed by ERCP addressed through a bile duct revision. The operation should be done necessarily open because with the laparoscopic procedures sufficient overview is achieved and severest injury of the biliary ducts.

Swell

• Disease in gastroenterology
• Disease in visceral surgery