Int J Gastrointest Interv.  2022 Jan;11(1):24-28. 10.18528/ijgii210018.

Mirizzi syndrome: A retrospective analysis of 84 patients from a single center

• Shafiq S
• Patil M
• Philip M

• KMID: 2525560
• DOI: http://doi.org/10.18528/ijgii210018

Abstract

Background
There is a paucity of literature regarding the prevalence of Mirizzi syndrome (MS) in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) for obstructive jaundice. We aimed to describe the clinical presentation; laboratory, imaging, and ERCP findings; and surgical management of patients with MS at our center.
Methods
A retrospective review was performed of the medical records of 3,852 consecutive patients who underwent ERCP between January 2010 to December 2019 at our center.
Results
MS was diagnosed in 84 (2.2%) of the patients who underwent ERCP, with 45 male and 39 female patients. Jaundice was the most common symptom (100%) followed by abdominal pain (91.6%). Leukocytosis and altered liver function tests were noted in all our patients. Although most of our patients had one or more pre-procedure imaging studies, MS was confirmed and subclassified based on cholangiographic and intraoperative findings. There were 11 post-cholecystectomy MS patients who opted for endoscopic therapy with repeated biliary stenting. Among the remaining 73 patients, 48 with type I and 21 with type II MS underwent open cholecystectomy, 4 with type III MS received cholecystectomy and choledochoduodenostomy, and another 4 patients with type II MS underwent subtotal cholecystectomy and choledochoplasty. Associated cystic duct abnormalities were noted in 20.2% of patients. Bile duct injuries occurred in 3 patients during an attempted laparoscopic procedure; however, no mortality was reported.
Conclusion
Although it is preferable to diagnose MS preoperatively, a preoperative diagnosis is seldom possible. ERCP is both a diagnostic and therapeutic procedure of choice before definitive surgery and helps to identify any associated cystic duct anomalies in these patients.

Keyword

Cholangitis; Cholecystectomy; Endoscopic retrograde cholangiopancreatography; Mirizzi syndrome; Obstructive jaundice