The Question of Mirizzi’s Syndrome

Abstract

Mirizzi’s syndrome develops secondary to calculous cholecystitis when a concretion of considerable size migrates from the gallbladder to the common hepatic or biliary duct. This produces a cholecysto-biliary fistula. Diagnosis of this pathology in the preoperative period has become possible due to the development of endoscopic techniques; thus, nowadays, it gives a positive result in 50% of cases in a chronic course of the disease. Nevertheless, the questions of etiology and classification of Mirizzi’s syndrome remain quite disputable. Over the past 15 years, 3,050 cholecystectomies have been performed in our clinic due to acute calculous cholecystitis. Mirizzi’s syndrome was detected in 11 patients. 10 patients were operated laparotomically and 1 patient laparoscopically. All patients were discharged from the hospital. Our observations have shown that the root cause of Mirizzi’s syndrome development is a functional biliary disorder (hypotonic extrahepatic biliary dyskinesia). This syndrome development may follow the following pattern: concretion formation – cholelithiasis development. The concretion located in the gallbladder neck or in the Hartmann pouch puts pressure on ductus choledochus thus narrowing its lumen and contributing to the inflammatory process development. Under the pressure of concretions, adjacent organs necrosis develops and a fistula is formed. The latter increases in size and the concretion gradually falls into the choledoch duct thus occluding its lumen. The existing classifications of Mirizzi’s syndrome are either rather cumbersome for everyday use or very similar and reflect the stages of migration of concretions from the gallbladder to ductus choledochus. While managing the syndrome, having sutured the fistula it is necessary to drain it. We give preference to internal drainage.