Mirizzi Syndrome: How it could be a challenge

Mirizzi syndrome (MS) is a rare complication of cholelithiasis. This entity should be considered in the differential diagnosis of all patients with obstructive jaundice. Failure to recognize this condition preoperatively can result in a major bile duct injury. In this study, our aim is to describe the clinical presentations, investigations, operative details, endoscopic management and the complications of both procedures.

We performed a retrospective analysis on the records of 65 patients with MS. All patients had a cholangiogram; either magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP). We used a McSherry classification to divide patients with MS into type I MS and type II MS. Those patients had undergone different types of management either ERCP and/or surgery.

The incidence of MS was 0.98% from a total of 4600 patients who had undergone cholecystectomy. From 65 patients with MS, 20 patients underwent ERCP where it was the sole treatment (18 of which had stent while 2 had the stone extracted). The overall surgically treated patients were 45 (23 patients with preliminary ERCP with stent and 22 patients with primary surgical treatment), 18 patients had MS type I while 27 patients had MS type II. Patients with different types of MS underwent different types of surgical procedures.