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Mirizzi's syndrome: a diagnostic dilemma
I N Masih1, R J Moorehead, G R Caddy
1Department of Gastroenterology, Ulster Hospital, Belfast, UK. izhaq@doctors.net.uk
Irish Journal of Medical Science
|April 16, 2009
Summary
Mirizzi syndrome, caused by gallstones compressing the common bile duct, can be difficult to diagnose definitively. Surgical exploration is often necessary to confirm the condition and differentiate it from other biliary strictures.
Area of Science:
- Gastroenterology
- Hepatobiliary Surgery
Background:
- Gallstones are common, but can lead to complications like biliary obstruction.
- Mirizzi syndrome is a rare complication involving extrinsic compression of the common bile duct by impacted gallstones.
Observation:
- A 62-year-old male presented with abdominal discomfort and was found to have gallstones and biliary dilatation.
- Imaging revealed a common bile duct stricture, initially suspected to be intrinsic.
- Laparotomy identified a large gallstone causing extrinsic compression, characteristic of Mirizzi syndrome.
Findings:
- The study highlights a case of Mirizzi syndrome presenting as a common bile duct stricture.
- Diagnosis was challenging, requiring surgical exploration to identify the extrinsic compression by a gallstone.
- Post-surgical intervention, repeat ERCP showed resolution of the stricture, underscoring the diagnostic dilemma.
Implications:
- Clinicians must consider Mirizzi syndrome in cases of unexplained biliary strictures, especially with a history of gallstones.
- Definitive diagnosis often necessitates surgical exploration due to limitations of non-invasive imaging and ERCP.
- Awareness of this condition can improve diagnostic accuracy and patient management in hepatobiliary disease.
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