Mirizzi's syndrome

A rare complication of gallstone disease

Diagram illustrating Mirizzi's syndrome

Mirizzi's syndrome is a rare complication of gallstone disease where a gallstone becomes impacted in the cystic duct or neck of the gallbladder, causing compression of the common bile duct or common hepatic duct. This can lead to obstructive jaundice and other complications.

Pathophysiology

Mirizzi's syndrome occurs when a gallstone becomes lodged in the cystic duct or the neck of the gallbladder. The impacted stone causes inflammation and swelling, which can compress the adjacent common bile duct. This compression can lead to obstruction of bile flow, resulting in jaundice and potentially cholangitis or pancreatitis.

Classification

Mirizzi's syndrome is classified into several types based on the extent of the ductal involvement:

• Type I: External compression of the common bile duct by a stone in the cystic duct or neck of the gallbladder.
• Type II: Formation of a cholecystocholedochal fistula, where the stone erodes into the common bile duct.
• Type III: Larger fistula with more extensive erosion into the common bile duct.
• Type IV: Complete destruction of the common bile duct wall.

Clinical Presentation

Patients with Mirizzi's syndrome typically present with symptoms of obstructive jaundice, including yellowing of the skin and eyes, dark urine, pale stools, and pruritus. They may also experience right upper quadrant abdominal pain, fever, and nausea.

Diagnosis

The diagnosis of Mirizzi's syndrome is often made using imaging studies. Ultrasound and CT scan can identify gallstones and ductal dilation. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) are more definitive tests that can visualize the biliary tree and identify the presence of a fistula.

Treatment

The treatment of Mirizzi's syndrome typically involves surgical intervention. The specific approach depends on the type of Mirizzi's syndrome and the extent of ductal involvement. Options include:

• Cholecystectomy: Removal of the gallbladder, often performed laparoscopically.
• Biliary reconstruction: In cases with fistula formation, reconstruction of the bile duct may be necessary.
• Endoscopic management: In some cases, ERCP with stenting may be used to relieve obstruction.

Prognosis

The prognosis for patients with Mirizzi's syndrome is generally good if diagnosed and treated appropriately. However, delayed diagnosis or treatment can lead to complications such as biliary cirrhosis or secondary biliary strictures.

Related pages

• Gallstone disease
• Cholecystitis
• Cholangitis
• Pancreatitis