Incidence, dianosis and management of Mirizzi syndrom in Kuwait

ABSTRACT

Mirizzi syndrome is an obstructive jaundice associated with pressure on the common hepatic duct from gallstones in Hartmann's pouch or the cystic duct. The stones sometimes erode through the main duct, leaving a fistula. We reviewed cases encountered between January 2001 and November 2002. Retrospective review of seventeen patients with diagnosis of Mirizzi syndrome managed in the surgical wards of Farwaniya Hospital. Patients were fully investigated including liver function tests, abdominal ultrasonography, ERCPand/or intra-operative cholangiography. During the study period 625 cholecystectomies were performed. Out of these, 17 were found to have Mirizzi syndrome which accounts for an incidence of 2.72%. In 11 patients, jaundice resulted from gallstone pressure [type I] and in the remaining six patients, the stones had eroded into the common hepatic duct producing a fistula [type II]. The diagnosis can usually be made preoperatively, especially if a large single stone is seen in conjunction with a dilated common hepatic duct and normal caliber common bile duct. We favor partial cholecystectomy, adding choledochoplasty using the gallbladder remnant, to close the fistula in type II cases