What Is Mirizzi Syndrome?

Mirizzi syndrome refers to a series of symptoms characterized by cholangitis and obstructive jaundice due to incarceration of stones in the gallbladder neck or gallbladder duct and / or compression or inflammation of other benign diseases that cause different degrees of obstruction of the common hepatic duct or common bile duct, leading to cholangitis and obstructive jaundice It is actually a complication of gallstones, not an independent disease. In 1983, the uterine malformer proposed the definition of Mirizzi syndrome, and classified the group of diseases that caused no gallbladder neck or gallbladder duct with no stones or incarceration of the gallbladder, but caused common duct stenosis due to gallbladder inflammation.

Basic Information

English name

Mirizzi syndrome

Visiting department

Gastroenterology

Multiple groups

Seniors with a history of gallstones

Common locations

gallbladder

Common causes

Gallbladder duct anatomy variation

Common symptoms

Abdominal pain, jaundice, high fever, chills, etc.

Causes of Mirizzi syndrome

Didlake et al. Emphasized that the anatomical variation of the gallbladder canal is related to the occurrence of the intrinsic. The basis of the lesion is: the opening of the gallbladder duct is too low or parallel to the common hepatic duct; the adjacent two duct walls are sometimes absent, with only a thin fibrous membrane covered with bile duct epithelium; sometimes the surrounding tissue forms a sheath-like structure, Wrapped with the common hepatic duct. Once such stones are embedded in the gallbladder duct, it is very easy to compress the common hepatic duct to narrow it, and even form a fistula. Other existing factors include: incarceration of stones in the gallbladder neck or gallbladder, gallbladder stones or inflammation compressing the common hepatic duct or inflammation involving the common hepatic duct. Pericystitis around the gallbladder, severe inflammation of the gallbladder triangle. Due to the decrease of the number of neurons in the common bile duct wall, the common bile ducts are impaired.

In the past, many scholars believed that large stones were the main factor for the occurrence of Mirizzi syndrome. After research, it was found that gallbladder stones with a size of 5 to 15 mm were easily embedded in the gallbladder neck or gallbladder duct, which caused the occurrence of Mirizzi syndrome. At the same time, it is also the most likely to cause gallbladder bile duct fistula, which has a incidence of 5.8 times that of other stones. The disease is a complicated pathological change caused by the compression of the common hepatic duct or the spread of inflammation. It is divided into five stages according to the severity of the disease: The common duct narrows due to the compression of the stones. Incarceration of gallbladder stones and inflammation of the gallbladder spread to the bile duct, and the inflammation subsided after cholecystectomy. Cholangitis, bile duct ulcers, bile duct stones, and common hepatic duct stenosis. cause gallbladder bile duct fistula. Scar stenosis and obstruction of common bile duct fibers. Different stages cause different clinical manifestations.

Clinical manifestations of Mirizzi syndrome

Clinically, there are many non-specific symptoms and signs of Mirizzi syndrome, and the clinical manifestations are not easily distinguishable from common bile duct stones. This disease is more common in the elderly. Most patients with Mirizzi syndrome have a history of gallstones, recurrent biliary colic and jaundice, and patients with cholangitis may have the typical triad of abdominal pain, jaundice, and high fever and chill; most patients have mild Degree of jaundice or history of jaundice may also be without jaundice. The gallbladder can be enlarged, atrophied, or unchanged in patients with Mirizzi syndrome. Most of the reports are atrophy of the gallbladder. The common hepatic duct can be normal, widened, or narrowed. There is common bile duct widening.

Mirizzi syndrome test

The clinical manifestations of Mirizzi syndrome are complex, non-specific, and there are no specific indicators in laboratory tests. The detection rate of imaging diagnosis is also very low, which objectively results in a low diagnosis rate of Mirizzi syndrome before surgery. Patients with a history of jaundice should consider the possibility of Mirizzi syndrome. Laboratory tests for abnormal liver function, such as elevated serum bilirubin, AST, and AKP, B-mode ultrasonographic atrophic gallbladder, "three-tube sign", or On ERCP and MRCP, it is seen that the gallbladder tube is too long or the gallbladder tube is parallel to the common hepatic duct. The "anti-C sign" must highly suspect Mirizzi syndrome.

1.B-ultrasound inspection;

2. Endoscopic retrograde cholangiopancreatography;

3.CT inspection;

4. Magnetic resonance cholangiopancreatography (MRCP)

MRCP is currently considered to be the best test for diagnosing Mirizzi syndrome.

Mirizzi syndrome treatment

Endoscopic treatment

In the past, because the endoscope could not access and remove the stones embedded in the neck of the gallbladder, it was not suitable for the treatment of Mirizzi syndrome. However, with the advancement of endoscopic cannula instruments and technology, some progress has been made in endoscopic treatment of Mirizzi syndrome

2. Surgical treatment

The central issue during Mirizzi syndrome surgery is to avoid common bile duct injury and correct existing common bile duct injury and stenosis. The principle of treatment should be to remove the diseased gallbladder, remove the stones, relieve the obstruction of the biliary tract, repair the bile duct defect and open the bile drainage.

3. Laparoscopic cholecystectomy (LC)

With the accumulation of laparoscopic surgery experience, the improvement of surgical technology, and the update of surgical instruments, LC has made a great breakthrough in the treatment of Mirizzi syndrome. However, many scholars do not advocate laparoscopic treatment in view of the anatomical variation of the gallbladder triangle and severe fibrous adhesions in patients with Mirizzi syndrome.