Chedid Marcio F, Chedid Aljamir D
Adult Liver Transplantation Program, Service of General Surgery, Hospital de Clínicas, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
Int Surg. 2007 Jul-Aug;92(4):198-201.
In 1948, Mirizzi described a syndrome characterized as the obstruction of the common hepatic duct by a stone located in the gallbladder's neck or in the cystic duct. We present a rare case of Mirizzi syndrome resulting from a fistula involving the cystic duct, the neck of the gallbladder, and the right hepatic duct. This finding was possible because the patient had a rare biliary anatomic variation: the insertion of the cystic duct straight in the right hepatic duct. The diagnosis was suggested by abdominal ultrasonography and confirmed by endoscopic retrograde cholangiopancreatography. The surgical approach was performed by means of an open cholecystectomy, common biliary duct exploration using the right hepatic duct and a transduodenal papillotomy, and insertion of a long limb T-tube through the right hepatic duct to drain the common duct. The procedure was successful, and after an 18-month period, the patient is free of symptoms.
1948年，米里齐描述了一种综合征，其特征为位于胆囊颈部或胆囊管的结石阻塞肝总管。我们报告一例罕见的米里齐综合征，其病因是瘘管累及胆囊管、胆囊颈部和右肝管。这一发现之所以成为可能，是因为该患者存在一种罕见的胆道解剖变异：胆囊管直接插入右肝管。腹部超声检查提示了诊断，并经内镜逆行胰胆管造影术得以证实。手术方法采用开腹胆囊切除术、经右肝管进行胆总管探查及经十二指肠乳头切开术，并通过右肝管插入一根长肢T形管以引流胆总管。手术成功，18个月后，患者无症状。
