Mirizzi Syndrome: Experience in Diagnosis and Treatment of 25 Cases

2012 ◽  
Vol 78 (1) ◽  
pp. 61-65 ◽  
Author(s):  
Hua Zhong ◽  
Jian-Ping Gong
Keyword(s):  
Magnetic Resonance ◽  
Preoperative Diagnosis ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Mirizzi Syndrome ◽  
Diagnosis And Treatment ◽  
Type I ◽  
Tube Insertion ◽  
Operative Strategy ◽  
T Tube

The objective of this study is to summarize the experience in diagnosis and treatment of Mirizzi syndrome (MS) and reduce the incidence of operative complications. Twenty-five cases of Mirizzi syndrome from January 2005 to January 2010 were retrospectively analyzed. There were 11 male patients and 14 female patients, ranging in ages from 26 to 80 years with a median age of 51.3. Preoperative radiological diagnosis was achieved in 10 patients: ultrasonography (n = 5) and magnetic resonance cholangiopancreatography (n = 10). The others were diagnosed intra-operatively. Fifteen patients had Type I MS. Two were treated with laparoscopic cholecystectomy successfully. The laparoscopic procedure had to be converted to open procedure in one patient. Seven patients had open complete cholecystectomy, three had subtotal cholecystectomy, and two had removal of stones from the gall bladder and choledochostomy after cholecystotomy was performed, with secondary cholecystectomy 3 months later. Six patients had Type II MS. Five underwent cholecystectomy, common bile duct (CBD) repair, and T-tube insertion. One was managed with transection of CBD and Roux-en-Y hepaticojejunostomy. Two patients with Type III MS underwent cholecystectomy, CBD repair, and T-tube insertion. Cholecystectomy and Roux-en-Y hepaticojejunostomy was performed in the two patients with Type IV MS. All the patients recovered from the operation. The follow-up period ranged from 5 years to 5 months. One patient developed obstructive jaundice more than 2 years after the operation, and recovered after the secondary operation. The follow-up of others were uneventful. Preoperative diagnosis of MS is very difficult. Magnetic resonance cholangiopancreatography is very helpful in preoperative diagnosis, and a high index of clinical suspicion is required to make a preoperative or intra-operative diagnosis, which can lead to correct operative strategy to manage Mirizzi syndrome.

Retropancreatic Retroperitoneal Tumors: A 30-year Experience with 38 Cases

2013 ◽  
Vol 79 (5) ◽  
pp. 470-475
Author(s):  
Tao-Tao Zhang ◽  
Ke-Jian Guo ◽  
Gang Ma ◽  
Shao-Wei Song
Keyword(s):  
Magnetic Resonance ◽  
Surgical Management ◽  
Malignant Tumors ◽  
Pancreatic Head ◽  
Magnetic Resonance Cholangiopancreatography ◽  
Uncinate Process ◽  
The Body ◽  
Number Of Patients ◽  
Retroperitoneal Tumors

Retropancreatic retroperitoneal tumors (RRTs) are seldom encountered in clinical practice. The lack of characteristics on clinical presentation and imaging make preoperative diagnosis difficult and surgical management remains a challenge. This retrospective report surveys the presenting diagnosis and surgical management of 38 patients with RRTs presenting at our center between August 1981 and May 2012. Six patients were misdiagnosed on the basis of computerized tomography and one each by magnetic resonance imaging and magnetic resonance cholangiopancreatography. Tumors were localized posterior to the pancreatic head and uncinate process (n = 18); posterior to the neck and body of the pancreas (n = 9); or posterior to the body and tail of the pancreas (n = 11). Thirty-three patients underwent surgical resections. Operative approaches were chosen on the basis of tumor size and localization. The tumors were mostly commonly originating from neurogenic tissue (n = 16). There were 25 benign neoplasms (65.8%), 10 malignant tumors (26.3%), and three undefined tumors. The morbidity of postsurgical complications was 21 per cent (eight of 38). The number of patients who underwent follow-up was 21, and the mean follow-up time was 35 months (range, 2 to 90 months). Three patients died during follow-up. The morbility of local recurrence was 10.5 per cent (four of 38). Definitive diagnosis of RRTs is made at laparotomy. Complete resection remains the fundamental objective of disease management. Different operative approaches should be used according to tumor localization and size.

Lymphatic Decompression Concomitant With Fontan/Kreutzer Procedure: Early Experience

2020 ◽  
Vol 11 (3) ◽  
pp. 284-292
Author(s):  
Christian Kreutzer ◽  
Daniel Alberto Klinger ◽  
Benjamin Chiostri ◽  
Santiago Sendoya ◽  
Mariana Lopez Daneri ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Arterial Oxygen ◽  
Type I ◽  
Resonance Imaging ◽  
Lymphatic Abnormalities ◽  
Cavopulmonary Anastomosis ◽  
Late Morbidity ◽  
Group A

Objective: To present a strategy for identifying patients at risk of lymphatic failure in the setting of planned Fontan/Kreutzer completion, allowing a tailored surgical approach. Methods: Since January 2017, clinical evaluation before performance of the Fontan/Kreutzer procedure included T2-weighted magnetic resonance imaging (MRI) lymphangiography. Thoracic lymphatic abnormalities were categorized using a scale of I to IV according to progression of severity. Patients with severe lymphatic abnormalities (types III and IV) underwent Fontan/Kreutzer with lymphatic decompression via connection of the left jugular–subclavian junction containing the thoracic duct to the systemic atrium (group A). Results: Thirteen patients were enrolled. Magnetic resonance imaging showed type I abnormalities in four cases (30.7%), II in four (30.7%), III in two (15.3%), and IV in three (23.3%). Patients in types III and IV underwent a Fontan/Kreutzer with lymphatic decompression (group A, n = 5), while patients in types I and II underwent a fenestrated extracardiac Fontan/Kreutzer procedure without lymphatic decompression (group B, n = 8). Preoperatively, there were no differences in age, weight, ventricular dominance (right vs left), superior vena cava pressure, incidence of chylothorax after previous superior cavopulmonary anastomosis (Glenn), or need for concomitant procedures at Fontan/Kreutzer completion. There were no differences in procedural times between the groups, nor were there differences in mortalities and Fontan/Kreutzer takedowns. There were no statistically significant differences in early and late morbidity between the two groups with the exception of total volume of effusions output postoperatively. At median follow-up of 18 months (range, 4-28 months), all patients in group A are in New York Heart Association class 1 with no differences between groups in arterial oxygen saturation. Conclusions: Lymphatic decompression during Fontan/Kreutzer procedure was successfully performed in patients identified by MRI as predisposed to lymphatic failure. A larger cohort of patients and longer follow-up are required to determine the efficacy of this approach in preventing early- and long-term Fontan/Kreutzer failure.

scholarly journals Mirizzi syndrome grades III and IV: surgical treatment

2016 ◽  
Vol 43 (4) ◽  
pp. 243-247 ◽  
Author(s):  
RONALD REVERDITO ◽  
ANDRÉ DE MORICZ ◽  
TÉRCIO DE CAMPOS ◽  
ADHEMAR MONTEIRO PACHECO JÚNIOR ◽  
RODRIGO ALTENFELDER SILVA
Keyword(s):  
Surgical Treatment ◽  
Preoperative Diagnosis ◽  
Anastomotic Stricture ◽  
Cross Sectional Study ◽  
Biliary Fistula ◽  
Mirizzi Syndrome ◽  
Cross Sectional ◽  
Biliodigestive Anastomosis ◽  
Type Iv

ABSTRACT Objective : to evaluate the epidemiology and outcomes of surgical treatment of patients with Mirizzi Syndrome (MS) grades III and IV, the most advanced according to Csendes classification. Methods : we conducted a retrospective, cross-sectional study by reviewing records of thirteen patients with grades III and IV MS operated from December 2001 to September 2013, among the 3,691 cholecystectomies performed in the period. Results : the incidence of MS was 0.6% (23 cases) and grades III and IV amounted to 0.35% of this number. There was a predominance of type IV (12 cases). The preoperative diagnosis was possible in 53.8% of cases. The preferred approach was biliary-digestive derivation (10 cases), and "T" tube drainage with suture of the bile duct was the choice in three special occasions. Three patients had biliary fistula resolved with clinical management, and one coliperitoneum case required reoperation. In the outpatient follow-up of patients who underwent biliodigestive anastomosis (eight), 50% are asymptomatic, 25% had anastomotic stricture and 25% lost follow-up. The mean follow-up was 41.8 months. Conclusion : MS in advanced degrees has low incidence, preoperative diagnosis in only half of cases, and has the biliodigestive anastomosis as the best conduct, but not without morbidity.

scholarly journals DIAGNOSE WITH “MIRIZZI SYNDROME”

2019 ◽  
Vol 31 (6) ◽  
pp. 2029-2033
Author(s):  
Simeon Simeonov
Keyword(s):  
Bile Ducts ◽  
Gallstone Disease ◽  
Biliary Fistula ◽  
Mirizzi Syndrome ◽  
Good Knowledge ◽  
Type I ◽  
Compression Process ◽  
External Compression ◽  
Operative Strategy ◽  
Surgical Tactics

Mirizzi syndrome is a rare but serious complication of the gallstone disease. In 1948 Pablo Luis Mirizzi for the first time described the so called ‘functional hepatic syndrome in patients ‘, who had obstructing concretion in d. cysticus causing cholestasis in the general bile duct by external compression. The compression, process of inflammation and wall ischemia result in erosion of the tissue engaged and appearance of various complications – abscess of the gallbladder, perivesicalar abscess, cholecystoduodenal fistula, stricture of bile ducts, biliary fistula. Mirizzi syndrome is still a challenge before the surgeon because of the a change in the normal anatomy and the severe process of inflammation. Good knowledge of the problem is essential for the accurate diagnosis and treatment. The operative strategy has two main goals – provision of efficient passage of the gall and reliable restoration of the hepato-choledochus. Choosing the surgical tactics during the operative intervention is of foremost importance – cholecystectomy in type I and restoration of the integrity of the bile ducts by T-tube drainage, plastic surgery of the hepato-choledochus or bilio-digestive anastomoses in type II-IV. The good knowledge of the problem and anatomic variations keeps safe the surgical team form iatrogenic lesions of the bile ducts and contributes for favourable postoperative results.

scholarly journals Laparoscopic Treatment of Type III Mirizzi Syndrome by T-Tube Drainage

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Fahri Yetışır ◽  
Akgün Ebru Şarer ◽  
H. Zafer Acar ◽  
Yılmaz Polat ◽  
Gokhan Osmanoglu ◽  
...  
Keyword(s):  
Cystic Duct ◽  
Normal Liver ◽  
Liver Function Tests ◽  
Mirizzi Syndrome ◽  
Laparoscopic Treatment ◽  
Tube Drainage ◽  
Type Iii ◽  
T Tube ◽  
Impacted Stone

Mirizzi syndrome (MS) is an impacted stone in the cystic duct or Hartmann’s pouch that mechanically obstructs the common bile duct. We would like to report laparoscopic treatment of type III MS. A 75-year-old man was admitted with the complaint of abdominal pain and jaundice. The patient was accepted as MS type III according to radiological imaging and intraoperative view. Laparoscopic subtotal cholecystectomy, extraction of impacted stone by opening anterior surface of dilated cystic duct and choledochus, and repair of this opening by using the remaining part of gallbladder over the T-tube drainage were performed in a patient with type III MS. Application of reinforcement suture over stump was done in light of the checking with oliclinomel N4 injection trough the T-tube. At the 18-month follow-up, he was symptom-free with normal liver function tests.

scholarly journals Legitimacy of Entry-Oriented Strategy in DeBakey I Dissection in the Era of Endovascular Therapy

2017 ◽  
Vol 20 (5) ◽  
pp. 184
Author(s):  
Tamer Ghazy ◽  
Utz Kappert ◽  
Ralf-Thorsten Hoffmann ◽  
Helena Hegelmann ◽  
Zuzana Fajfrova ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Endovascular Therapy ◽  
Ascending Aorta ◽  
Type I ◽  
Operative Strategy ◽  
Group I ◽  
Imaging Results ◽  
Group Ii ◽  
Intimal Tear

Background: Legitimacy of entry-oriented therapy for DeBakey I aortic dissection is of eminent importance in the era of emerging ascending aorta endovascular therapy. This study aims to evaluate early, midterm, and reintervention results of entry-oriented operative strategy compared to more aggressive strategies for treatment of DeBakey type I aortic dissection with an isolated intimal tear in the ascending aorta.Methods: This study prospectively followed 98 consecutive patients who received an operation for DeBakey type I aortic dissection with the intimal tear in the ascending aorta between 2007 and 2013 for up to 6 years. Follow-up included survival, medical therapy, CT-imaging results, and reinterventions. Patients were grouped into entry-oriented (group I) receiving an isolated replacement of the ascending aorta and/or hemiarch (65 patients); and aggressive therapy (group II) receiving a replacement of the ascending aorta and complete aortic arch (33 patients). Results: The in-hospital mortality was 19% and 23% respectively. The 3-year survival was 52% and 47% respectively (P = .193). Group II showed no advantage regarding persistence or progression of the dissection, thrombosis of false lumen, increase in aortic diameter, peripheral organ malperfusion (as assessed by follow-up computed tomography imaging) or freedom from reintervention. Conclusion: In treating DeBakey I aortic dissection with an entry tear in the ascending aorta, it might be legitimate to adopt an entry-oriented operative strategy. Further research is also needed to clearly describe the indication of extending the operative strategy in such cases.

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