This study was conducted at King Sand Hospital (350 beds), Al-
Qa,ssirn Region, Saudia Arabia; between December 2000 till May 2005.
The aim of this work is to describe a series of 13 patients presented with
obstructive jaundice and proved to have Mirizzi syndrome, at a single institution,
submitted to surgical treatment and to comment on their aspects
with emphasis on the diagnosis and treatment The following items were
evaluated: clinical presentation, laboratory results, preoperative evaluation,
operative findings,type of Mirizzi syndrome according to the classification
of Csendes et a1,1989, choice of operative procedures, and complications.
The study comprised 13 patients (5 males & 8 females with mean age
58.2+9.3 years) with MS detected out of 1834 patients (0.7%) treated for
cholelithiasis during the period of the study. Preoperative radiological examination
succeeded in the diagnosis of MS in 6 cases; 2 cases by ultrasonography
(15.4%), 4 cases by ERCP (30.8%), one out of 4 cases by CT
(25%) and one out of 4 cases by MRCP (25%) and failed to diagnose 7
cases with a success rate of 46.2%. Surgical exploration through a right
subcostal incision detected the presence of impacted stone in the infundibulum
of the gallbladder or in the cystic duct of the all patients; there
were 4 patients (30.8%) with MS type 1, 3 patients (23.1%) had MS type
II, 2 patients (15.4%) had MS type HI and 4 patients (30.8%) had MS type
IV. The surgical procedure done was cholecystectomy for patients with
type I MS, Cholecystectomy, primary closure of the cholecysto-bilicuy fistula
and T- tube drainage of CHD for patients with MS type II. Patients
with MS type III underwent cholecystectomy and choledochodunrienostorny, while cholecystectomy and Roux-en-Y hepaticojejunostorny
were done for patients with MS type W. Liver function tests
returned to normal whips in all patients within 43.8+20.7 days (range:
30-70 days postoperatively) and the mean duration of post-operative follow-
up was 20.7+12.8 months (range: 6-48 months) with no postoperative
major procedure-related complications or mortality.
• It could be concluded that MS is an uncommon form of benign obstructive
jaundice identified with a frequency of 0.7% of patients with cholelithiasis.
The preoperative diagnosis of Mirizzi syndrome is difficult and an
awarded suspicion is necessary to avoid injuries of the biliary tree. The
problem may only become evident during the operation due to firm adhesions
around Cabot's triangle. The success of the treatment is related to a
precocious recognition of the condition during surgery, and adapting the
management according to the individual characteristics of each case. |
