Mirizzi’s syndrome

Rare complication of long-standing gallstones, resulting in obstructive jaundice.

Occurs in 0.7-1.1% of all patients undergoing cholecystectomy.

Type I-involves external compression of the common hepatic duct by a large stone impacted at the cystic duct or Hartmann’s pouch, type II-involves a cholecystocholedochal fistula, caused by a stone eroding into the common bile duct.

Ultrasound and ERCP are sensitive and specific entities that can provide a preoperative diagnosis.

ERCP can provide drainage to relieve cholangitis.

Patients usually have a shrunken gallbladder with adhesions and inflammatory changes.

Removal of the entire gallbladder increases the risk of bile duct injury.

General management is a partial cholecystectomy for type I syndrome as it removes the gallstones, resolves the obstructive jaundice and prevents late strictures formation.

For type II syndrome the treatment depends on the size of the fistula and the condition of surrounding tissues: primary repair of the fistula or biliary-enteric anastomosis are undertaken.

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