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Mirizzi Syndrome

Mirizzi's syndrome


Presentation

  • Symptoms of recurrent cholangitis, jaundice, right upper quadrant pain, and elevated bilirubin and alkaline phosphatase may or may not be present. Acute presentations of the syndrome include symptoms consistent with cholecystitis.[en.wikipedia.org]
  • Normal appearing bile can also be present. Various species of bacteria can be found in 11% to 30% of the cases. Rokitansky-Aschoff sinuses are present 90% of the time in cholecystitis specimens.[ncbi.nlm.nih.gov]
  • There is no specific clinical or laboratory presentation for Mirizzi syndrome.[scielo.br]
Inflammation
  • In most patients; an open operation is preferred over a laparoscopic procedure because of the extreme anatomic distortion that is present in the triangle of Calot as a result of the intense inflammation.[medscape.com]
  • The obstructive jaundice can be caused by direct extrinsic compression by the stone or from fibrosis caused by chronic cholecystitis (inflammation).[en.wikipedia.org]
  • Such inflammation is characteristic of Mirizzi syndrome and can be used to distinguish biliary conditions, including cancer.[emedicine.medscape.com]
Fever
  • Complication of CHOLELITHIASIS characterized by OBSTRUCTIVE JAUNDICE; abdominal pain, and fever.[connects.catalyst.harvard.edu]
  • Since the onset, she had no nausea or vomiting, no chills or fever, no significant weight loss. She had no appreciable loss of appetite. She had a 20-year history of gallstones.[journals.sagepub.com]
  • The most characteristic and frequently occurring symptoms were dull pain in the upper right quadrant of the abdomen — 58 (68.2%), jaundice and symptoms of cholangitis (chills, fever) — 42 (49.4%).[reports-vnmedical.com.ua]
  • Obstructive jaundice is the key feature of Mirizzi’s syndrome and is frequently accompanied by pain and fever. This presentation often suggests acute cholangitis. Rarely, patients may be anicteric at … Zusammenfassung.[bgtlm.co]
  • Method: A case is detailed herein of a 67-year-old man who presented with abdominal pain, fever, and jaundice. A dilated bile duct was found on ultrasound, but the gallbladder could not be seen.[ncbi.nlm.nih.gov]
Physician
  • ., 20th century Argentinian physician. Mirizzi syndrome - stenosis of hepatic duct. Synonym(s): hepatic duct obstruction[medical-dictionary.thefreedictionary.com]
  • Eponym [ edit ] It is named for Pablo Luis Mirizzi (1893–1964), an Argentinian physician. Mirizzi was educated and trained in his hometown and later visited some of the best hospitals throughout the United States for further education and training.[en.wikipedia.org]
  • Information Pediatrics Performance Improvement Performance Measures Perioperative Care and Consultation Pharmacoeconomics Pharmacoepidemiology Pharmacogenetics Pharmacy and Clinical Pharmacology Physical Medicine and Rehabilitation Physical Therapy Physician[jamanetwork.com]
Sepsis
  • Nonetheless, it is important to remember that not all patients improve with stenting, and long-term complications such as sepsis and secondary biliary cirrhosis can develop.[medscape.com]
  • One (12.5%) patient presented a postoperative sepsis due to a sub-hepatic abscess, and was reoperated. There was no operative mortality.[scielo.br]
  • During the operation, dissection of the Calot’s triangle may lead to bile duct injury or excessive bleeding and other morbidity such as sepsis, delayed bile duct stricture, and secondary biliary cirrhosis[ 14, 26, 28, 48, 53 ].[ncbi.nlm.nih.gov]
Falling
  • The common bile duct was firstly adopted as the cystic duct, giving the impression that it falls into the gallbladder. In addition, it was impossible to visualize the proximal part of the common bile duct.[websurg.com]
Upper Abdominal Pain
  • The classic physical examination will demonstrate right upper abdominal pain with deep palpation (Murphy's sign). Patients are usually not acutely ill but are uncomfortable.[ncbi.nlm.nih.gov]
  • Case presentation A 52-year male patient N. was admitted urgently on 24.02.2011 with severe upper abdominal pain, which was especially marked in the right hypochondrium. He had nausea and repeated bile vomiting.[cyberleninka.org]
  • Background The incidence of Mirizzi syndrome (MS) is low and only 0.06%–5.7% of patients with gallstones have the typical symptoms of right upper abdominal pain, with or without jaundice and fever. 1 However, these symptoms are not typical for all patients[journals.sagepub.com]
Colic
  • Patients who present with acute biliary colic are often worked up for cardiac issues.[ncbi.nlm.nih.gov]
  • However, it is only symptomatic in 20–30% of patients, with biliary pain “colic” being the most Gallstones cause various problems besides simple biliary colic and choplecystitis.[bgtlm.co]
Jaundice
  • As a result, the CHD/CBD becomes obstructed by either scar or stone, resulting in obstructive jaundice. It can be divided into four types.[en.wikipedia.org]
  • Conservative treatment was undertaken, and symptoms of acute cholecystitis and jaundice gradually resolved. 2.[cyberleninka.org]
  • Gradually jaundice accompanied by darker urine and white, clay-like feces had appeared.[journals.sagepub.com]

Workup

  • Jaundice is usually present, and at times, significantly elevated bilirubin can be identified. [6] Evaluation The routine workup for cholecystitis should be initiated.[ncbi.nlm.nih.gov]

Treatment

  • So, the use of highly sensitive diagnostic methods and a combination of endoscopic and surgical treatment can significantly improve the results of treatment of patients with Mirizzi syndrome. References 1. Alidzhanov, F. B., Rizaev, K.[reports-vnmedical.com.ua]
  • Treatment of Mirizzi Syndrome Surgical management is the mainstay treatment for Mirizzi Syndrome, although this is challenging for several reasons.[ncbi.nlm.nih.gov]
  • Soriani P...Manno M 2019 3 Laparoscopic subtotal cholecystectomy for Mirizzi syndrome: A report of a case. ( 30684815 ) Kimura J...Mizokami K 2019 4 An Elderly Woman with Abdominal Pain: Mirizzi Syndrome. ( 30910995 ) Mohseni M...Graham C 2019 5 Novel treatment[malacards.org]

Prognosis

  • The diagnosis of gallbladder cancer must be ruled out before or during surgery and an appropriate surgery must be performed because a second surgery to perform oncologic surgery has a poorer prognosis and outcome than a one-stage radical surgery[ 14 ][ncbi.nlm.nih.gov]

Etiology

  • The first published paper describing the syndrome which bears his name today was in 1940. [1] Etiology Gallstones are usually formed from bile that is in stasis.[ncbi.nlm.nih.gov]

Epidemiology

  • There is no evidence of race having any bearing on the epidemiology. Eponym [ edit ] It is named for Pablo Luis Mirizzi (1893–1964), an Argentinian physician.[en.wikipedia.org]
  • This causes subsequent inflammation of the are which can also lead to fistula formation over time. [2] Epidemiology Epidemiology of gallstones must first be understood. Most gallstones are asymptomatic.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • Surgery is extremely difficult as Calot's triangle is often completely obliterated and the risks of causing injury to the CBD are high. [2] Pathophysiology [ edit ] Multiple and large gallstones can become impacted in the Hartmann's pouch of the gallbladder[en.wikipedia.org]
  • The pathophysiology of gallstone ileus resembles that of Mirizzi syndrome.[ncbi.nlm.nih.gov]

Prevention

  • Transplantation Substance Use and Addiction Surgery Surgical Innovation Surgical Pearls Teachable Moment Technology and Finance The Rational Clinical Examination Tobacco and e-Cigarettes Toxicology Trauma and Injury Treatment Adherence United States Preventive[jamanetwork.com]
  • In one (12.5%) anicteric patient, intra-operative cholangiography was not performed due to the finding of an extremely fine cystic duct that prevented its catheterization.[scielo.br]
  • New strategies to prevent laparoscopic bile duct injury-surgeons can learn from pilots. Surgery. 2002; 132 :826–835 [ PubMed ] [ Google Scholar ] 11. Martin IG, Dexter SPL, Marton J, Gibson J, Asker J, Firullo A, McMahon MJ.[ncbi.nlm.nih.gov]
  • Occluding cystic duct stones prevent complete filling of the cystic duct. More recently, MR cholangiopancreatography has been used to examine the gallbladder and cystic duct in the setting of acute cholecystitis.[pubs.rsna.org]

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