Mirizzi's syndrome must be ruled out in the differential diagnosis of any patients with obstructive jaundice.

BACKGROUND/AIMS: Mirizzi syndrome is a rare benign complication of long-standing cholelithiasis and neither diagnostic modality nor clinical feature has a 100% sensitivity and specificity. The objective of our study was to call attention to the importance of this rare syndrome with its miscellaneous treatments.

METHODOLOGY

Between January 1992 and June 1997, a total of 8 (4 females and 4 males) patients, who were operated and diagnosed as Mirizzi syndrome, were retrospectively evaluated.

RESULTS

The mean age was 53.75 years. During the same time period 0.98% of the total 812 cholelithiasis patients were Mirizzi syndrome. The ultrasound was used in 7, computed tomography (CT) in 4 and endoscopic retrograde cholangiopancreatography (ERCP) in 2 cases. Ultrasound allowed the detection of cholelithiasis in all, but proximal bile duct dilatation in only 71% of cases. CT detected the non-specific findings of syndrome in 75% of cases. In 2 patients, because of the difficulties due to the patients themselves and the technical management problems. ERCP could not detect the pathology properly. In 2 of 5 type I patients, we performed only cholecystectomy and in another 2 cholecystectomy plus T-tube drainage. In 1 case, due to major hepatic duct injury during surgery, cholecystectomy plus hepaticojejunostomy over the Y-stent was performed. Biliary fistula developed in 1 patient with T-tube drainage and was successfully managed with conservative treatment. In all type II patients we preferred cholecystectomy plus choledochoduodenostomy and all of them were free of complications.

CONCLUSIONS

If there is no question about the security of the common bile duct at surgery in type I patients, we recommended cholecystectomy, otherwise cholecystectomy plus exploration of common bile duct and/or drainage should be the procedure of choice. However, in type II patients cholecystectomy plus choledochoduodenostomy is a safe and effective procedure to perform.