Mirizzi Syndrome
| Classification according to ICD-10 | |
|---|---|
| K83.1 | Closure of the bile duct |
| ICD-10 online (WHO version 2019) | |
As Mirizzi's syndrome is a rare form of obstructive jaundice , which is the jaundice due to a relocation of the bile ducts , respectively. It occurs when the common hepatic duct is compressed by a calculus in the neck of the gallbladder or in the cystic duct . Only about every thousandth patient with gallstone disease has Mirizzi syndrome. A long common history of common hepatic duct and the cystic duct with deep junction favors this condition. It was described by Pablo L. Mirizzi in 1948 , but had been known since 1905.
Symptoms
The symptoms are similar to those of a common bile duct stone : upper abdominal pain, nausea , colic , increasing jaundice, acholic stool, beer-brown urine and steatorrhea . Symptoms of cholecystitis are not uncommon.
diagnosis
The cholestasis parameters ( alkaline phosphatase , bilirubin etc.) are greatly increased. To determine the position of the calculus, an upper abdominal sonography or an endosonography is necessary. Other mechanical blockages of the bile outflow must be excluded from the differential diagnosis: tumors , strictures, in third world countries also parasites such as roundworms . The location of the stone in Mirizzi syndrome is atypical for obstructive jaundice.
therapy
The gall bladder must be removed and any choledocholithiasis either removed preoperatively using ERCP or addressed intraoperatively with a bile duct revision. The operation should definitely be carried out openly, because laparoscopy does not provide a sufficient overview and there is a risk of severe injuries to the biliary tract.
Individual evidence
- ↑ D. Hazzan et al. a .: Combined endoscopic and surgical management of Mirizzi syndrome . In: Surg Endosc . , 1999, 13 (6), pp. 618-620.
- ^ RL Toscano u. a .: Mirizzi syndrome. In: Am Surg. , 1994, 60 (11), pp. 889-891.
- ^ PL Mirizzi: Syndrome del conducto hepatico . In: J Int de Chir. , 1948, 8, pp. 731-777.
