Khan Muhammad Rizwan, Ur Rehman Sameer
Department of Surgery, Aga Khan University & Hospital, Stadium Road, Karachi, 74800, Pakistan.
J Med Case Rep. 2012 Jun 15;6:157. doi: 10.1186/1752-1947-6-157.
Mirizzi's syndrome is a rarely observed disorder that presents with obstructive jaundice. The condition is caused by a stone impacted in the gall bladder neck or cystic duct that impinges on the common hepatic duct, with or without a cholecystocholedochal fistula. The condition is often confused with other serious conditions such as hilar cholangiocarcinoma, which present with similar clinical and imaging findings, and a pre-operative diagnosis may be a serious challenge.
We present the case of a 44-year-old Asian man with Mirizzi's syndrome who was initially diagnosed as having cholangiocarcinoma based on his clinical presentation, raised cancer antigen 19-9 levels and radiological findings. Our patient was diagnosed as having Mirizzi's syndrome intra-operatively and subsequently a cholecystectomy was performed with restoration of biliary drainage. Careful clinical assessment during surgery with the help of intra-operative frozen section helped in establishing the definitive diagnosis and altered the surgical procedure for our patient.
Pre-operative diagnosis of Mirizzi's syndrome could be challenging as the clinical, biochemical and radiological presentation is similar to other conditions causing obstructive jaundice such as choledocholithiasis, bile duct stricture or cholangiocarcinoma. A high index of suspicion and careful surgical assessment may help in establishing a diagnosis and alter the clinical course for our patient.
Mirizzi综合征是一种罕见的疾病，表现为梗阻性黄疸。该病由胆囊颈部或胆囊管内的结石压迫肝总管引起，可伴有或不伴有胆囊胆总管瘘。该疾病常与其他严重疾病混淆，如肝门部胆管癌，它们具有相似的临床和影像学表现，术前诊断可能是一项严峻挑战。
我们报告一例44岁亚洲男性Mirizzi综合征病例，该患者最初根据临床表现、癌胚抗原19-9水平升高及影像学检查结果被诊断为胆管癌。我们的患者在术中被诊断为Mirizzi综合征，随后进行了胆囊切除术并恢复了胆汁引流。术中借助冰冻切片进行仔细的临床评估有助于明确诊断，并改变了我们患者的手术方式。
Mirizzi综合征的术前诊断具有挑战性，因为其临床、生化及影像学表现与其他导致梗阻性黄疸的疾病（如胆总管结石、胆管狭窄或胆管癌）相似。高度的怀疑指数和仔细的手术评估可能有助于确诊并改变患者的临床病程。
