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KMID : 0378019820250070049
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New Medical Journal
1982 Volume.25 No. 7 p.49 ~ p.52
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Mirizzi Syndrome
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Abstract
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Mirizzi syndrome is an unusal cause of obstructive jaundice. It consists of the following
elements;(1) impaction of a gallstone in the cystic duct or neck of the gallbladder,
(2) an anatomic arrangement of the cystic duct such that it lies almost parallel to the common hepatic duct, (3) partial mechanical obstruction of the common hepatic duct by the stone itself or the resulting inflammatory reaction, and (4) recurrent cholangitis or ultimately cholangitic cirrhosis due to the partial obstruction.
Recently we have experienced a case of the syndrome and report it with review of literatures.
A 54 year old male was admitted to St. Mary´s Hospital, Catholic Medical College because of jaundice and right upper quadrant pain for 5 days. For 5 years prior to admission, he had intermittent right upper quadrant pain and radiating back pain.
Physical examination showed the skin to be yellowish and there was mild tenderness over the right upper quadrant. Liver function test revealed significant elevation of serum bilirubin, SGOT, SGPT, and alkaline phosphatase.
Simple X-ray films of the abdomen only showed nonspecific reflex ileus. A few small echoes were seen in the gallbladder on ultrasonography. PTC revealed the cystic duct to be markedly dilated and lie parallel to the common hepatic duct. There was a sharply defined, rounded filling defect at the distal portion of the cystic duct, representing impacted stone. The common hepatic duct was obstructed at the lesion and moderately dilated proximal to it.
The exploratory laparatomy was performed and demonstrated cholangitis with a large stone impaction in the distal cystic duct compressing the common hepatic duct. Much inflammatory reaction and adhesion were noted in this area. But bilio-biliary fistula was not developed. Postoperative T-tube cholangiography revealed the contrast media to be well spilled into the lumen of the duodenum, and only showed smooth indentation at lateroposterior portion of the distal common hepatic duct due to inflammatory adhesion.
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KEYWORD
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