Pitfalls in the management of Mirizzi's syndrome.

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dc.contributor.authorSharma, A Ken_US
dc.contributor.authorRangan, H Ken_US
dc.contributor.authorChoubey, R Pen_US
dc.contributor.authorThakur, S Ken_US
dc.contributor.authorKumar, Aen_US
dc.date.accessioned1998-04-30en_US
dc.date.accessioned2009-06-04T03:33:46Z
dc.date.available1998-04-30en_US
dc.date.available2009-06-04T03:33:46Z
dc.date.issued1998-04-30en_US
dc.description.abstractPressure on the common hepatic duct due to a gallstone impacted in Hartmann's pouch or cystic duct results in jaundice and cholangitis. Repeated episodes of inflammation and pressure necrosis lead to the formation of a cholecysto-choledochal fistula (Mirizzi's syndrome Type I & II). Preoperative diagnosis is difficult and a formal cholecystectomy may lead to bile duct injury. Of the 792 patients operated upon for symptomatic gallstone disease from June 1992 to June 1997 at our centre, 18 patients (2%) had Mirizzi's syndrome. There were 11 females and 5 males, with a mean age of 48 (SD 20; range 20-74) years. Thirteen patients (81%) presented with cholangitis. Ultrasound scan suggested the diagnosis of carcinoma gallbladder in 9 (56%). Endoscopic Retrograde Cholangiopancreatography (ERCP) confirmed the diagnosis in 16. Cholecystectomy was done by the fundus first technique. A complete cholecystectomy was done only if there was no cholecysto-choledochal fistula (n = 5), otherwise a cuff of gallbladder was used to repair the bile duct (n = 10). Hepatico-jejunostomy was done to drain the fistula in one patient. A T-tube drain was placed in the common bile duct (CBD) and a cholangiogram done, before closing the abdomen in all. Histology revealed carcinoma in fundus of gallbladder in one patient (6%). One patient died of haemobilia 3 weeks after operation. Wound infection developed in 5 (30%) patients and 12 (75%) have been followed up for a median period of 28 months. One patient developed a biliary stricture with intrahepatic stones and later underwent a hepatico-jejunostomy. Two have undergone repair of incisional hernia. High index of clinical suspicion, ERCP to clinch the diagnosis, NBD to drain the infected bile, a fundus first partial cholecystectomy and primary repair of CBD, followed by a peroperative T-tube cholangiogram, usually leads to a satisfactory outcome.en_US
dc.description.affiliationGastroenterology Centre (Medical and Surgical), Army Hospital (Research & Referral), Delhi. lilki@giasdi101.vsnl.net.inen_US
dc.identifier.citationSharma AK, Rangan HK, Choubey RP, Thakur SK, Kumar A. Pitfalls in the management of Mirizzi's syndrome. Tropical Gastroenterology. 1998 Apr-Jun; 19(2): 72-4en_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/124357
dc.language.isoengen_US
dc.source.urihttps://www.tropicalgastro.comen_US
dc.subject.meshBiliary Fistula --etiologyen_US
dc.subject.meshCholangiopancreatography, Endoscopic Retrogradeen_US
dc.subject.meshCholangitis --etiologyen_US
dc.subject.meshCholecystectomyen_US
dc.subject.meshCholelithiasis --complicationsen_US
dc.subject.meshCommon Bile Duct Diseases --etiologyen_US
dc.subject.meshDrainageen_US
dc.subject.meshFemaleen_US
dc.subject.meshGallbladder Diseases --etiologyen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshMiddle Ageden_US
dc.subject.meshRetrospective Studiesen_US
dc.subject.meshSyndromeen_US
dc.titlePitfalls in the management of Mirizzi's syndrome.en_US
dc.typeJournal Articleen_US
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