scholarly journals Mirizzi syndrome management

2016 ◽  
Vol 11 (4) ◽  
Author(s):  
JU R Ashraf
Keyword(s):  
Abdominal Pain ◽  
Clinical Presentation ◽  
Descriptive Study ◽  
Mirizzi Syndrome ◽  
Type I ◽  
Type Ii ◽  
T Tube ◽  
Uncommon Presentation ◽  
Upper Abdominal ◽  
Work Up

Objective: The aim of this study was to assess the clinical presentation and management of Mirizzi syndrome. Study Design: Descriptive study. Patients and Methods: During 2 year at Ittefaq Hospital Lahore 10 patients came with Mirizzi syndrome by chance. All patients presented with upper abdominal pain, jaundice and palpable gallbladder. ERCP was inconclusive in 5 patients preoperatively. Rest of 5 patients undergo surgery and on table cholangiogram was performed. Results: All the patients undergo surgery after pre-operative work up. ERCP in 5 patients and peroperative cholangiogram in 5 patients was inconclusive. Nine patients had type-I Mirizzi syndrome and 1 patient had type-II Mirizzi syndrome. Simple cholecystectomy was` performed in 9 patients but in 1 patient (type-II) after cholecystectomy T-tube was placed in common bile duct. Postoperatively T-tbe was removed after T-tube cholangiogram. Conclusion: Mirizzi syndrome is a uncommon presentation of gallstone. Its diagnosis is confirmed on cholangiog raphy and can be treated surgically safely.

scholarly journals Mirizzi Syndrome: An Experience in Laparoscopic Era

2021 ◽  
Vol 11 (4) ◽  
pp. 165-167
Author(s):  
Syed Hussain ◽  
Asrar Ahmad ◽  
Muhammad Mughal ◽  
Irum Saleem ◽  
Saqib Islam
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Mirizzi Syndrome ◽  
Military Hospital ◽  
Type I ◽  
Type Ii ◽  
Surgical Department ◽  
Type Iii ◽  
T Tube ◽  
Type Iv ◽  
Tube Closure

Objective:To assess the presentation and surgical management of Mirrizi syndrome patients who underwent LaparoscopicCholecystectomy. Study Design and Setting:Retrospective Descriptive Study was conducted at Surgical Department Combined MilitaryHospital Rawalpindi and Combined Military Hospital Quetta from 1st Jan 2010 to 20th Jan 2016. Methodology:Patients undergoing laparoscopic cholecystectomy during this period were retrospectively reviewed. Allcases of Mirizzi Syndrome (MS) were identified and data analysed. Results:A total of 5500 patients underwent laparoscopic cholecystectomy during this period. Approximately 26(0.47%)cases were identified to be having MS. Out of these 26 cases only 8 (30%) were males while 18 (70%) were females. Ageranged from 25 to 80 years. Three patients (11%) had an endoscopic retrograde cholangiopancreaticography (ERCP) done.Type-I MS was found in 19 cases (73 %), Type-II in 3 cases (11%), Type-III and Type-IV in 2 cases each (7.69 %).Conversion to open surgery was carried out in 15 cases (57.6 %). All type-I MS had cholecystectomy except one casewhere partial cholecystectomy was done. T-tube closure of common bile duct was done in all Type-II MS. Similarly T-tube closure was possible in two cases of type-III while one hadRoux-en-Y hepaticojejunostomy. All cases of type-IV MS had Roux-en-Y hepaticojejunostomy. One patient out of 26 (3.8 %) had carcinoma gallbladder. There was no mortality. Conclusion:Type-I MS can be managed with laparoscopic cholecystectomy in selected patients.Type-II and type-III MS may need placement of T-tube while most of type-IV MS are managed with Roux-en-Y hepaticojejunostomy.

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.

Suprasellar Rathke Cleft Cysts; Clinical Presentation and Treatment Outcomes

Neurosurgery ◽  
2011 ◽  
Vol 69 (5) ◽  
pp. 1058-1069 ◽  
Author(s):  
Matthew B. Potts ◽  
Arman Jahangiri ◽  
Kathleen R. Lamborn ◽  
Lewis S. Blevins ◽  
Sandeep Kunwar ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Clinical Presentation ◽  
Optic Chiasm ◽  
Magnetic Resonance Images ◽  
Type I ◽  
Type Ii ◽  
Visual Dysfunction ◽  
Kaplan Meier ◽  
Laboratory Results ◽  
Suprasellar Extension

Abstract BACKGROUND Rathke cleft cysts (RCCs), benign remnants of the Rathke pouch typically arising in the sella, sometimes have suprasellar extension. Purely suprasellar RCCs are rarely reported. OBJECTIVE To compare the presentations, surgical outcomes, and pathology of purely suprasellar RCCs and sellar-based RCCs. METHODS We retrospectively reviewed records, magnetic resonance images, laboratory results, and pathology of 151 RCC patients surgically managed at our institution from 1989 to 2009. The RCCs were classified as purely sellar (type I, n = 76), sellar with suprasellar extension (type II, n = 56), or purely suprasellar (type III, n = 19). RESULTS The RCCs with a suprasellar component (types II and III) more commonly presented with visual dysfunction (P < .001). Complete cyst drainage occurred in 89%, 55%, and 38% of type I, II, and III RCCs, respectively (P < .001). Vision improved in 100%, 55%, and 33% and headache improved in 74%, 64%, and 29% of type I, II, and III patients, respectively (P = .02). Temporary or permanent postoperative diabetes insipidus occurred in 5%, 16%, and 21% of type I, II, and III patients, respectively. (P < .001). In a multivariate analysis, RCC type was the only factor predicting recurrence. Kaplan-Meier 3-year recurrence/progression rates were 0%, 16%, and 29% for type I, II, and III RCCs, respectively (P < .001, type I vs II, type I vs III; P = .5 type II vs III). CONCLUSION The RCCs with a suprasellar component are neurosurgically challenging because of their proximity to the optic chiasm and infundibulum. Compared with sellar-based RCCs, RCCs with a suprasellar component more frequently present with visual dysfunction, are more difficult to completely eliminate, recur more frequently, and are associated with higher postoperative endocrine morbidity, and their preoperative visual dysfunction and headache less frequently improve with surgery. These factors must be considered during the treatment of RCCs with a suprasellar component.

scholarly journals Effect of nutritional intake towards Angular cheilitis of orphanage children

2016 ◽  
Vol 28 (3) ◽  
Author(s):  
Nurdiani Rakhmayanthie ◽  
Erna Herawati ◽  
Dewi Marhaeni Diah Herawati
Keyword(s):  
Oral Cavity ◽  
Vitamin B12 ◽  
Food Consumption ◽  
Descriptive Study ◽  
Nutritional Intake ◽  
Type I ◽  
Oral Manifestations ◽  
Type Ii ◽  
Food Frequency ◽  
Intake Level

Introduction: Angular cheilitis is one of the oral manifestations of iron, vitamin B12, and folate deficiency. This manifestation frequently seen in people at first and second decade. The purpose of this study was to obtain the prevalence of angular cheilitis and its classifications related to the nutritional intake level in 6-18 years old children. Methods: This research was a descriptive study with 53 children between 6-18 years old from Muhammadiyah Orphanage Bandung as the samples. The oral cavity was examined clinically and their food consumption in a week was noted in Food Recall 24 hours and Food Frequency Questionnaire (FFQ) in order to measure their nutritional intake level. Results: There are 23 children with angular cheilitis. 13% has iron and folate deficiencies, and 87% has iron, vitamin B12, and folate deficiencies. Angular cheilitis types that has been found are Type I (39%), Type II (48%) and Type III (13%). Conclusion: The prevalence of angular cheilitis in 6-18 years old children in Muhammadiyah Orphanage Bandung was moderately high, most of them were having iron, vitamin B12, and folate deficiencies. Type II angular cheilitis was the most frequently seen.

scholarly journals Novel variants in a patient with late-onset hyperprolinemia type II: diagnostic key for status epilepticus and lactic acidosis

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jeremias Motte ◽  
Anna Lena Fisse ◽  
Thomas Grüter ◽  
Ruth Schneider ◽  
Thomas Breuer ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Lactic Acidosis ◽  
Epileptic Seizures ◽  
Vitamin B ◽  
High Dose ◽  
Type Ii ◽  
Unknown Compound ◽  
Pyridoxine Deficiency ◽  
Work Up ◽  
Hyperprolinemia Type Ii

Abstract Background Hyperprolinemia type 2 (HPII) is a rare autosomal recessive disorder of the proline metabolism, that affects the ALDH4A1 gene. So far only four different pathogenic mutations are known. The manifestation is mostly in neonatal age, in early infancy or early childhood. Case presentation The 64-years female patient had a long history of abdominal pain, and episode of an acute neuritis. Ten years later she was admitted into the neurological intensive-care-unit with acute abdominal pain, multiple generalized epileptic seizures, a vertical gaze palsy accompanied by extensive lactic acidosis in serum 26.0 mmol/l (reference: 0.55–2.2 mmol/l) and CSF 12.01 mmol/l (reference: 1.12–2.47 mmol/l). Due to repeated epileptic seizures and secondary complications a long-term sedation with a ventilation therapy over 20 days was administered. A diagnostic work-up revealed up to 400-times increased prolin-level in urine CSF and blood. Furthermore, a low vitamin-B6 serum value was found, consistent with a HPII causing secondary pyridoxine deficiency and seizures. The ALDH4A1 gene sequencing confirmed two previously unknown compound heterozygous variants (ALDH4A1 gene (NM_003748.3) Intron 1: c.62 + 1G > A - heterozygous and ALDH4A1 gene (NM_003748.3) Exon 5 c.349G > C, p.(Asp117His) - heterozygous). Under high-dose vitamin-B6 therapy no further seizures occurred. Conclusion We describe two novel ALDH4A1-variants in an adult patient with hyperprolinemia type II causing secondary pyridoxine deficiency and seizures. Severe and potentially life-threatening course of this treatable disease emphasizes the importance of diagnostic vigilance and thorough laboratory work-up including gene analysis even in cases with atypical late manifestation.

scholarly journals Diagnosis and classification of Mirizzi syndrome

2020 ◽  
Vol 87 (3-4) ◽  
pp. 26-30
Author(s):  
I. N. Mamontov
Keyword(s):  
Treatment Method ◽  
Mirizzi Syndrome ◽  
Diagnostic Process ◽  
Type I ◽  
Type Ii ◽  
Results Of Treatment ◽  
Diagnosis And Classification ◽  
Definite Kind ◽  
Variant Anatomy

Objective. To determine the factors, predisposing to development of Mirizzi syndrome; to improve diagnosis and classification of it, taking into account of these factors and possibilities to apply a definite kind of endoscopic or operative treatment. Materials and methods. Retrospective analysis was done for results of treatment of 21 patients with Mirizzi syndrome: Type I in accordance to classification of McSherry (1982) was present in 7 patients, while a Type II - in 14. Results. There was established, that atypia (the variant anatomy) of the ductus cysticus localization predisposes for contact between hepaticocholedochus and a gallbladder of with ductus cysticus, leading to development of Mirizzi syndrome Types I and II. Squeezing (Type I) or fistula (Type II) are observed on any level of hepaticocholedochus. In syndrome of Mirizzi Type II the duct distal to fistula may be not dilated (Subtype IIA) or dilated (Subtype IIB). Conclusion. Atypia (the variant anatomy) of the ductus cysticus duct constitute a factor, promoting development of Mirizzi syndrome. While diagnostic process for Mirizzi syndrome it is necessary to take into account a localization of squeezing of hepaticocholedochus or of fistula, presence of atypia of the ductus cysticus and its stump localization, character of the gallbladder inflammation, quantity and size of calculi. Proposition to include the Types IIA and IIB II in Mirizzi syndrome, depending on the dilation degree present in hepaticocholedochus distally, to the fistula, constitutes a substantiated principle, because it takes into account a possibility to perform endoscopic lithoextraction and to impact the choice of the surgical treatment method.

scholarly journals Upper Abdominal Primary Retroperitoneal Cyst with Unusual Urothelial Histogenesis - An Uncommon Presentation Masquerading as a Hepatic Cyst

2020 ◽  
pp. 1-3
Author(s):  
Arun Gopinath ◽  
Ahmad Alkhasawneh ◽  
Arun Gopinath ◽  
Brett Baskovich ◽  
Civan Altunkaynak ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Laparoscopic Resection ◽  
Hepatic Cyst ◽  
Rare Occurrence ◽  
Case Presentation ◽  
Uncommon Presentation ◽  
Retroperitoneal Cyst ◽  
Rare Lesion ◽  
Upper Abdominal ◽  
Primary Retroperitoneal

Background: Benign retroperitoneal cysts are uncommon. There is a paucity of literature on primary upper abdominal retroperitoneal cysts of urothelial histogenesis. We report an uncommon presentation of urothelial cyst clinically mimicking a hepatic cyst. Case presentation: A 21-year old female patient was admitted with intermittent abdominal pain of 9 months duration diagnosed on radiology as a right hepatic cyst. Laparoscopic resection and pathologic examination revealed a primary retroperitoneal cyst with a urothelial histogenesis. This is an unusual clinical presentation of a rare lesion mimicking a hepatic cyst. Conclusion: This case highlights the unusual anatomic location and the rare occurrence of an upper abdominal retroperitoneal urothelial cyst.

scholarly journals Tremor Types in Parkinson Disease: A Descriptive Study Using a New Classification

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Alexandre Gironell ◽  
Berta Pascual-Sedano ◽  
Ignacio Aracil ◽  
Juan Marín-Lahoz ◽  
Javier Pagonabarraga ◽  
...  
Keyword(s):  
Parkinson Disease ◽  
Descriptive Study ◽  
Categorical Variables ◽  
Type I ◽  
Type Ii ◽  
Action Tremor ◽  
Type Iii ◽  
Resting Tremor ◽  
Type Iv

Background. The current classification of tremor types in Parkinson disease (PD) is potentially confusing, particularly for mixed tremor, and there is no label for pure resting tremor. With a view to better defining the clinical phenomenological classification of these tremors, our group relabeled the different types as follows: pure resting tremor (type I); mixed resting and action tremor with similar frequencies (type II) divided, according to action tremor presentation, into II-R when there is a time lag and II-C otherwise; pure action tremor (type III); and mixed resting and action tremor with differing frequencies (type IV). We performed a descriptive study to determine prevalence and clinical correlates for this new tremor classification. Patient/Methods. A total of 315 consecutively recruited patients with PD and tremor were clinically evaluated. X2 tests were used to assess tremor type associations with categorical variables, namely, sex, family history of PD, motor fluctuations, and anticholinergic and beta-blocker use. With tremor type as the independent variable, ANOVA was performed to study the relationship between dependent quantitative variables, namely, age, age at PD diagnosis, disease duration, and UPDRS scores for rigidity. Results. The studied patients had tremor types as follows: type I, 30%; type II, 50% (II-R, 25% and II-C, 25%); type III, 19%; and type IV, 1%. No significant association was found between the studied clinical variables and tremor types. Conclusions. Mixed tremor was the most common tremor type in our series of patients with PD according to our proposed classification, which we hope will enhance understanding of the broad clinical phenomenology of PD.

scholarly journals Multi-level Split Cord Malformation: Do We Need a New Classification?

2014 ◽  
Vol 4 ◽  
pp. 32 ◽  
Author(s):  
Gmaan A Alzhrani ◽  
Hosam M Al-Jehani ◽  
Denis Melançon
Keyword(s):  
Systematic Review ◽  
Clinical Presentation ◽  
Split Cord Malformation ◽  
Type I ◽  
Type Ii ◽  
Imaging Findings ◽  
New Classification ◽  
Live Births ◽  
Female Predominance ◽  
Multi Level

Split cord malformations (SCMs) are thought to be rare abnormalities representing 3.8-5% of all spinal cord anomalies. The prevalence is estimated to be 1 in 5499 live births (0.02%), with a slight female predominance (1.3:1). Although the estimates of prevalence vary, Type I SCM occurs more frequently than Type II SCM. In this paper, we are reporting the clinical presentation and imaging findings of multi-level SCM in a 27-year-old male. A literature review of the embryological background of SCM and pathological hypothesis for this entity is provided. A systematic review has been conducted to identify multi-level SCM cases reported in the literature, followed by proposing a new classification system to further our understanding and management of SCMs.

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