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Category: Volume 06 Issue 02 February 2018
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Title: Clinical Profile and Management of Mirizzi's Syndrome- Ten years Experience in a Tertiary Care Hospital in a Developing Country

Authors: Muzafar Bashir, Aijaz Ahmad Malik, Nadeem Ul Nazeer, Showkat Ali Zargar

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i2.87

Abstract

Background: Mirizzi’s syndrome (MS) is defined as an extrinsic compression of common hepatic duct from an impacted stone in cystic duct or Hartmann’s pouch. Sometimes stones erode through main duct leading to fistula formation. Preoperative awareness is necessary to avoid intra operative complications because of altered anatomy locally. The aim of this study was to assess magnitude of syndrome in patients getting operated for cholelithiasis, role of pre-operative evaluation [laboratory and radiological or endoscopic retrograde cholangio pancreaticography (ERCP)] for suspecting the syndrome and subsequent role of ERCP and various surgical procedures.

Methods: The study was descriptive conducted both retrospectively and prospectively. In the retrospective group, all records, demographic characteristics, clinical features, laboratory investigations, imaging, surgical records and histopathological examination (HPE) were reviewed. In the prospective group, patients who had suspicion of MS underwent specific investigations and subsequent surgery if needed.

Results: During study period of ten years, 6286 patients underwent cholecystectomy. Out of these 150 patients were diagnosed to have MS with an incidence of 2.3%. Pain right hypochondium was the most common presenting feature. Type- I MS was most common (82.6%). Most common laboratory abnormality was raised alkaline phosphatase (ALP, increased in 87% of patients) and bilirubin (increased in 52% patients). Ultrasonographic (USG) finding were suggestive in 61.3%, ERCP and magnetic resonance cholangio pancreaticography (MRCP) in 34.6% and 4.0% respectively. Majority were treated with choleystectomy only. Overall complications after ERCP procedures were 6.8% and 5.3% patients developed complications post operatively. No patient underwent a laparoscopic procedure.

Conclusion: Type –I MS was most common because of high incidence of gallstone disease in our state. Pre-operative suspicion can be made by a combined evaluation approach including high bilirubin and ALP, USG finding suggestive of MS, MRCP, while ERCP can be diagnostic as well as a good palliation procedure but surgery is the definitive treatment.

Keywords: Mirizzi’s syndrome; MS, surgical management; ERCP; Endoscopic retrograde cholangio pancreaticography; Cholecystectomy.

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Corresponding Author

Dr Muzafar Bashir

Address Kharibagh, Chadoora, Budgam , 191113, INDIA

Phone number 7006407055, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.