Publications of Faculty of Medicine:MIRIZZI SYNDROME: A DIAGNOSTIC AND SURGICAL PROBLEM: Abstract

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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.