Mirizzi's syndrome : lessons learnt from 169 patients at a single center :lessons learnt from 169 patients at a single center

Ashok Kumar; Ganesan Senthil; Anand Prakash; Anu Behari; Rajneesh Kumar Singh; Vinay Kumar Kapoor; Rajan Saxena

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저자정보: Ashok Kumar (Sanjay Gandhi Post Graduate Institute of Medical Sciences) Ganesan Senthil (Sanjay Gandhi Post Graduate Institute of Medical Sciences) Anand Prakash (Sanjay Gandhi Post Graduate Institute of Medical Sciences) Anu Behari (Sanjay Gandhi Post Graduate Institute of Medical Sciences) Rajneesh Kumar Singh (Sanjay Gandhi Post Graduate Institute of Medical Sciences) Vinay Kumar Kapoor (Sanjay Gandhi Post Graduate Institute of Medical Sciences) Rajan Saxena (Sanjay Gandhi Post Graduate Institute of Medical Sciences)

저널정보: 한국간담췌외과학회 Annals of Hepato-Biliary-Pancreatic Surgery 한국간담췌외과학회지 제20권 제1호

발행연도: 2016.2

수록면: 17 - 22 (6page)

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Backgrounds/Aims: Mirizzi’s syndrome (MS) poses great diagnostic and management challenge to the treating physician. We presented our experience of MS cases with respect to clinical presentation, diagnostic difficulties, surgical procedures and outcome. Methods: Prospectively maintained data of all surgically treated MS patients were analyzed. Results: A total of 169 MS patients were surgically managed between 1989 and 2011. Presenting symptoms were jaundice (84%), pain (75%) and cholangitis (56%). Median symptom duration s was 8 months (range, ＜1 to 240 months). Preoperative diagnosis was possible only in 32% (54/169) of patients based on imaging study. Csendes Type II was the most common diagnosis (57%). Fistulization to the surrounding organs (bilio-enteric fistulization) were found in 14% of patients (24/169) during surgery. Gall bladder histopathology revealed xanthogranulomatous cholecystitis in 33% of patients (55/169). No significant difference in perioperative morbidity was found between choledochoplasty (use of gallbladder patch) (15/89, 17%) and bilio-enteric anastomosis (4/28, 14%) (p=0.748). Bile leak was more common with choledochoplasty (5/89, 5.6%) than bilio-enteric anastomosis (1/28, 3.5%), without statistical significance (p=0.669). Conclusions: Preoperative diagnosis of MS was possible in only one-third of patients in our series. Significant number of patients had associated fistulae to the surrounding organs, making the surgical procedure more complicated. Awareness of this entity is important for intraoperative diagnosis and consequently, for optimal surgical strategy and good outcome.

#Mirizzi syndrome #Cholestasis #Bile duct disease

참고문헌 (20)

참고문헌 신청

Pemberton M, Wells AD. The Mirizzi syndrome. Postgrad Med J 1997;73:487-490.

Csendes A, Díaz JC, Burdiles P, Maluenda F, Nava O. Mirizzi syndrome and cholecystobiliary fistula: a unifying classification. Br J Surg 1989;76:1139-1143.

Redaelli CA, Büchler MW, Schilling MK, Krähenbühl L, Ruchti C, Blumgart LH, et al. High coincidence of Mirizzi syndrome and gallbladder carcinoma. Surgery 1997;121:58-63.

Prasad TL, Kumar A, Sikora SS, Saxena R, Kapoor VK. Mirizzi syndrome and gallbladder cancer. J Hepatobiliary Pancreat Surg 2006;13:323-326.

Beltran MA, Csendes A, Cruces KS. The relationship of Mirizzi syndrome and cholecystoenteric fistula: validation of a modified classification. World J Surg 2008;32:2237-2243.

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