Management of Mirizzi Syndrome in a Tertiary Care Centre of Southern India- A Series of 10 Cases

Abstract

Mirizzi syndrome is a rare condition characterised by obstructive jaundice due to compression of Common Hepatic Duct (CHD) by a stone impacted in the neck of gall bladder. Incidence is around 1-2% in patients with symptomatic cholelithiasis. Preoperative diagnosis and management is challenging. Authors have retrospectively analysed the records of patients undergoing cholecystectomy in our institute for the past five years and selected those patients who had final diagnosis of Mirizzi syndrome were reviewed and following results were arrived. From January 2016 to February 2021, 446 patients underwent cholecystectomy. Out of these, 10 (2.24%) patients had final diagnosis of Mirizzi syndrome. Male:Female ratio was 3:7. Mean age at presentation was 49.5 years. Most common presenting symptoms were pain abdomen and jaundice. Mirizzi syndrome was preoperatively diagnosed only in 3 (30%) patients. Others were diagnosed during surgery. Type I in four patients, type II in three patients, type III in two patients and type IV in one patient. These patients were treated with either total or subtotal cholecystectomy. Open approach was used in 8 (80%) patients and laparoscopic approach in 2 (20%) patients. Biliary drainage procedure was done in all patients, T-tube drainage in 5 (50%); Roux-en-Y Hepaticojejunostomy (HJ) in 3 (30%) and Hepaticoduodenostomy in 2 (20%) patients. Thus, the authors concluded Mirizzi syndrome being one of a rare complication of long standing cholelithiasis, which poses a challenging task for diagnosis and management. High index of suspicion is required to identify and treat Mirizzi syndrome in order to avoid bile duct injuries.

Keywords

• choledocholithiasis
• cholelithiasis
• hepaticojejunostomy
• hepaticoduodenostomy