Vudayagiri Lahari, Mujahed Omar F, Mellert Logan, Gemma Rick
General Surgery, Western Reserve Hospital, Cuyahoga Falls, USA.
Cureus. 2021 Oct 30;13(10):e19144. doi: 10.7759/cureus.19144. eCollection 2021 Oct.
Mirizzi syndrome (MS) is a rare complication of chronic cholecystitis caused by the gallbladder wall compression of the common hepatic duct (MS1, based on McSherry classification) or as a cholecystocholedochal fistula (MS2). The incidence of MS in symptomatic cholelithiasis is very low. Patients often present with obstructive jaundice and right upper quadrant abdominal pain; symptoms not clinically unique from biliary colic or cholecystitis, and often misdiagnosed preoperatively. We present the case of a 76-year-old female, initially diagnosed with chronic cholecystitis, who was found to have MS2 intraoperatively. She denied a prior history of abdominal surgery or biliary instrumentation. The patient underwent a subtotal cholecystectomy with common bile duct exploration, t-tube placement, and wide local drainage. She progressed well and was discharged home from the hospital on day seven with outpatient hepatobiliary surgery follow-up. At one-month follow-up, the patient had t-tube output of 200-300cc per day with remaining drains removed after having diminished output and no signs of biloma on CT. At the two-month follow-up, the patient had a minimal t-tube output with t-tube cholangiography showing contrast dye into the duodenum. Her t-tube was clamped and was removed at the three-month follow-up. Surgical management of MS1 is generally laparoscopic or open cholecystectomy. Management of MS2 is complex and dependent on anatomic and pathologic factors. Surgical repair generally focuses on biliary-enteric reconstruction, with cholecystcholedochoduodenostomy or Roux-en-Y hepaticojejunostomy. Conservative surgical approach with subtotal cholecystectomy, common bile duct exploration, and biliary drainage is also reported as a safe alternative option. MS is a rare complication of chronic cholecystitis, and can be a cause of cholecystocholedochal fistula, which is often discovered intraoperatively during cholecystectomy; general surgeons should be familiar with conservative management of MS.
Mirizzi综合征（MS）是慢性胆囊炎的一种罕见并发症，由胆囊壁压迫肝总管（根据McSherry分类为MS1）或作为胆囊胆总管瘘（MS2）引起。MS在有症状的胆石症中的发病率非常低。患者常表现为梗阻性黄疸和右上腹腹痛；这些症状在临床上与胆绞痛或胆囊炎并无独特之处，术前常被误诊。我们报告一例76岁女性病例，最初诊断为慢性胆囊炎，术中发现为MS2。她否认有腹部手术或胆道器械操作史。该患者接受了胆囊次全切除术、胆总管探查、T管置入及广泛局部引流。她恢复良好，术后第7天出院，门诊进行肝胆外科随访。在1个月的随访中，患者每天T管引流量为200 - 300cc，引流液减少后其余引流管拔除，CT显示无胆汁瘤迹象。在2个月的随访中，患者T管引流量极少，T管胆管造影显示造影剂进入十二指肠。其T管被夹闭，并在3个月的随访中拔除。MS1的手术治疗一般为腹腔镜或开腹胆囊切除术。MS2的治疗较为复杂，取决于解剖和病理因素。手术修复通常侧重于胆肠重建，采用胆囊胆总管十二指肠吻合术或Roux-en-Y肝空肠吻合术。也有报道称，采用胆囊次全切除术、胆总管探查和胆道引流的保守手术方法是一种安全的替代选择。MS是慢性胆囊炎的罕见并发症，可导致胆囊胆总管瘘，常在胆囊切除术中被发现；普通外科医生应熟悉MS的保守治疗。
