Mirizzi syndrome is a rare complication of gallbladder disease that can be difficult to treat. In particular, endoscopic treatment often fails because of the inability to access or to capture the impacted cystic duct stone. We report a case of Mirizzi syndrome grade III that was successfully managed by digital single-operator peroral cholangioscopy-guided electrohydraulic lithotripsy with endoscopic nasogallbladder drainage and interval laparoscopic cholecystectomy. Based on our experience, digital single-operator peroral cholangioscopy-guided electrohydraulic lithotripsy with endoscopic nasogallbladder drainage is a feasible minimally invasive approach for the management of high-grade Mirizzi syndrome.
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Difficult Biliary Stones: A Comprehensive Review of New and Old Lithotripsy Techniques Edoardo Troncone, Michelangela Mossa, Pasquale De Vico, Giovanni Monteleone, Giovanna Del Vecchio Blanco Medicina.2022; 58(1): 120. CrossRef
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Mirizzi Syndrome Type IV Successfully Treated with Peroral Single-operator Cholangioscopy-guided Electrohydraulic Lithotripsy: A Case Report with Literature Review Hirokazu Kawai, Toshifumi Sato, Masaaki Natsui, Kotaro Watanabe, Ryosuke Inoue, Mayuki Kimura, Kazumi Yoko, Syun-ya Sasaki, Masashi Watanabe, Taku Ohashi, Akihiro Tsukahara, Norio Tanaka, Yoshihisa Tsukada Internal Medicine.2022; 61(23): 3513. CrossRef
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Chang Gyun Chun, M.D., Do Hyun Park, M.D., Ji Won Lyu, M.D., Yun Suk Shim, M.D., Jeong Hoon Park, M.D., Suck-Ho Lee, M.D., Hong-Soo Kim, M.D., Sang-Heum Park, M.D. and Sun-Joo Kim, M.D.
Korean J Gastrointest Endosc 2007;34(1):60-64. Published online January 30, 2007
Mirizzi syndrome is commonly defined as a common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct. Mirizzi syndrome has traditionally been treated surgically. However, there are several case reports and small series describing endoscopic and percutaneous alternatives to open surgery. We encountered two cases of type I Mirizzi syndrome that was successfully treated endoscopically. We report these cases with a review of the relevant literature.
The Mirizzi syndrome, obstructive jaundice due to inflammatory or direct compression of common duct is an uncommon complication of longstanding cholecystitis, caused by a cystic duct stone or impacted stone of gallbladder neck. Mirizzi syndrome with resulting repeated attack of inflammation and pressure necrosis leads to the formation of cholecy- stocholedochal fistulas, rarely(Mirizzi syndrome type II), The cholecystocholedochal fistula is very difficult to recognize on preoperative state, and constitute a high risk of damage to the common duct during a cholecystectomy, Since jaundice is the main problem, abdominal sonography and following ERCP(Endoscopic retrograde cholangiopan-creatography) are the primary radiologic tests. But. these findings are so non-specific that exact diagnosis is made in operation room, frequently. We experienced a 67-year-old male patient who complained repeated right upper quadrant pain. On his sonography, dilatation of intrahepatic and common hepatic duct showed and stone was likely to place in the proximal common duct, but gallbladder and cystic duct was not visualized. In operation the gallbladder was identified likely to diverticulum on the common duct and large fistula was present between them. Partial cholecystectomy and Roux-en Y choledochojejunostomy was done. The patient fell in sepsis and discharged hopelessly. (Korean J Gastrointest Endosc 17: 437-442, 1997)
Mirizzi syndrome is a so-called functional hepatic syndrome with obstruction of the common hepatic duct secondary to pressure from an impacted stone, either in the cystic duct or the neck of the gallbladder. Mirizzi syndrome is classified into two types based on endoscopic retrograde cholangio-pancreatographic findings. Type I involves external compression of the common hepatic duct by a large stone impacted in the cystic duct or Hartmann's pouch. In type II, a chole-cystocholedochal fistul is present, caused by a calculus which has eroded partly or completely into the common bile duct. Gallstone obstruction of the cystic duct with resulting repeated attacks of inflammation and pressure necrosis leads to the formation of cholecystocholedochal fistulas. We experienced a 70-year-old female patient with Mirizzi syndrome type II, who complained of abdominal discomfort. ERCP revealed multiple filling defects in contracted gallbladder, which compressed lateral wall of common hepatic duct. Peroral cholangioscopy revealed an impacted stone at the neck of the gallbladder with neighboring mucosal erosions. She was treated under the diagnosis of Mirzzi syndrome type II by endoscopic biliary drainage and surgical operation.