CASE REPORT   

Minerva Medica 1999 May-June;90(5-6):179-86

Copyright © 1999 EDIZIONI MINERVA MEDICA

language: Italian

Mirizzi’s syndrome

Vadalà G., Basile G., Rimmaudo G., Pappalardo A., Evola G., Vadalà S.

Mirizzi's syndrome is a rare, but well described cause of obstructive jaundice which occurs in less than 1% of patients presenting for cholecystectomy. The syndrome is due to a stone impacted in the cystic duct or in the neck of gallbladder, causing compression or obstruction of the common epatic duct. The clinic, physiopathologic, diagnostic and therapeutic aspects of this disease are described. The patient observed, arrived in emergency with obstructive jaundice and hyperpyrexia. Echography showed a remarkable dilatation of the biliary ducts, whereas endoscopic retrograde cholangiography (ERCP) showed an obstruction of the hepatic common duct of undefinable nature (stone, neoplasy). The surgical operation performed in emergency made clear the diagnostic doubt. Since inflammation impacted biliary duct and gallbladder, an incision of the gallbladder at its fundus was performed. In this way it was possible to extract about 40 stones of dimensions less than 1 cm, and one of 3¥1 cm, impacted in the cystic duct, compressing the common hepatic duct. A partial cholecystectomy was performed and no connection between gallbladder and common epatic duct (fistula) was found. The surgical operation led to complete resolution of the symptomatology. Therefore, the conclusions is drawn that Mirizzi's syndrome a rare but non infrequent pathology, finds its definition and complete resolution with surgical operation. Mirizzi's syndrome or obstructive jaundice due to extrinsic compression of principal biliary duct by a stone impacted in the cystic duct, is an uncommon complication of cholecystic lithiasis. Although this syndrome is rare (1%), it causes obstructive jaundice, sometimes dangerous, and serious complications as recurrent cholangitis.