Title: An Unusual Complication of Gallstones: Mirizzi Syndrome - A Case Report and Literature Review
Authors: Adnan Bashir Bhatti, MD, Farhan Ali, Siddique Akbar Satti
DOI: http://dx.doi.org/10.18535/jmscr/v4i10.01
Mirizzi syndrome is a rare complication of gallstone disease, causing major biliary problems, if the diagnosis is not made early. This condition was also reported to occur in the setting of acute acalculous cholecystitis. It was first described in 1948 by Pablo Mirizzi and presented itself in the form of unusually lodged gallstone in either the cystic duct or most frequently in Hartmann pouch of the gallbladder. We report a 50-year-old female with exquisite pain in right hypochondrium and epigastrium with nausea and vomiting for the last 20 days. She also had yellowish discoloration of urine, clay-colored stools, and tender right hypochondrium. Laboratory investigations revealed raised liver enzymes and ultrasonography (USG) was inconclusive in describing an impacted stone in gallbladder neck. Computerized tomography (CT) scan and magnetic resonance cholangiopancreatography (MRCP) revealed it as suspected case of a mirizzi syndrome which was later confirmed by surgery. The patient was recovered after surgery without complications. Keywords: Mirizzi syndrome; Cholelithiasis; MRCP; gallstones. 1. Beltrán MA. Mirizzi syndrome: History, current knowledge and proposal of a simplified classification. World Journal of Gastroenterology : WJG. 2012;18(34): 4639-4650. doi:10.3748/wjg.v18.i34.4639. 2. Milone M, Musella M, Maietta P, et al. Acute acalculous cholecystitis determining Mirizzi syndrome: case report and literature review. BMC Surgery. 2014; 14:90. doi:10.1186/1471-2482-14-90. 3. Ludmil M. Veltchev1, Manol A. Kalniev2, Todor A. Todorov3 Mirizzi Syndrome-Rare cause of major biliary complications. Case Report. Journal of IMAB - Annual Proceeding (Scientific Papers) 2009, Volume 15, book 1, 92 – 94 doi: 10.5272/jimab.1512009_92 4. Lengyel BI, Panizales MT, Steinberg J, Ashley SW, Tavakkoli A. Laparoscopic cholecystectomy: What is the price of conversion? Surgery. 2012;152(2):173-178. doi:10.1016/j.surg.2012.02.016. 5. Mattila A, Luhtala J, Mrena J et al. An audit of short- and long-term outcomes after laparoscopic removal of common bile duct stones in Finland. Surg Endosc. 2014 Dec; 28(12):3451-7. doi: 10.1007/s00464-014-3620-9. Epub 2014 Jun 18. 6. Kibe, W. W. The Role of Laparoscopy in the Management of Mirizzi's Syndrome: A Review of Literature. World Journal of Laparoscopic Surgery, 2011; 4(3), 174-176. 7. Yonetci, N., Kutluana, U., Yilmaz, M., Sungurtekin, U., & Tekin, K. (2008). The incidence of Mirizzi syndrome in patients undergoing endoscopic retrograde cholangiopancreatography. Hepatobiliary Pancreat Dis Int, 7(5), 520-524. 8. Safioleas M, Stamatakos M, Safioleas P, Smyrnis A, Revenas C, Safioleas C. Mirizzi Syndrome: an unexpected problem of cholelithiasis. Our experience with 27 cases. Int Semin Surg Oncol. 2008;5:12. 9. Al-Akeely MH, Alam MK, Bismar HA, Khalid K, Al-Teimi I, Al-Dossary NF. Mirizzi syndrome: ten years experience from a teaching hospital in Riyadh. World J Surg. 2005;29:1687–1692. 10. Toscano RL, Taylor PH, Peters J, Edgin R. Mirizzi syndrome. Am Surg. 1994;60:889–891. 11. Lai EC, Lau WY. Mirizzi syndrome: history, present and future develop-ment. ANZ J Surg.2006;76:251–257. 12. Gomez D, Rahman SH, Toogood GJ, Prasad KR, Lodge JP, Guillou PJ, Menon KV. Mirizzi’s syndrome--results from a large western experience. HPB (Oxford) 2006;8:474–479. 13. 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. Abstract
References