The Mirizzi Syndrome –Major Cause for Biliary Duct Injury during Laparoscopic Cholecystectomy
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2017, Vol 1, Issue 3
Abstract
After the introduction of laparoscopy as a method of choice for cholecystectomy, the amount of the biliary injury of the main bile duct has raised significantly. Primary cause for this is complicated cholecystitis with gallstone impacted in theHartmann’s pouch, also known as Mirizzi syndrome.The chronic complications of symptomatic gallstone disease, or Mirizzi syndrome, are named after Dr.Pablo Luis Mirizzi [1], an Argentinean surgeon who first performed intra-operative cholangiography in 1931 to obtained visual impression of the bile duct tree, and who in late 1948 described chronic complications of gallstone cholecystitis. Till the end of the 80’s the laparotomy is the main method for treatment of gallbladder stone decease. The introduction of mini invasive methods makes laparoscopy the first choice. But in 1, 5% [2] of the cases, predominantly in Mirizzi syndrome, the laparoscopic operation became the main reason for the increase of iatrogenic irrevocable injury of the main bile ducts. This, on its own, requires laparotomy and performance of bilio-digestive anastomosis, which significantly compromises the laparoscopy.For this reason we need to perform preoperative imaging diagnosis and to precise the options to perform save laparoscopic Cholecystectomy in complicated cases.Mirizzi syndrome is a chronic complication of impacted gallstone, usually more than 10m min diameter at Hartmann’s pouch of the gallbladder. This provokes obstruction of cystic duct followed by dilation of gallbladder, chronic inflammation of the wall and forming of intraluminal pressure with influence on the stone. Under this pressure the impacted stone presses the bladder’s tissues surface of contact and provokes anatomical inflammatory changes at triangle of Callot’s normal anatomy such as: a. Shortening of distance between cystic duct and common hepatic duct and compressing of the impacted stone on the wall of CHD with stenosis and mechanical jaundice. b. Dilation, shortening and disappearing of cystic duct, with protrusion of stone in the lumen of CBD c. Forming of large fistula between gallbladder and CHD.
Authors and Affiliations
Ludmil MARINOV
Keywords
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- EP ID EP572655
- DOI 10.26717/BJSTR.2017.01.000308
- Views 169
- Downloads 0
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