Mirizzi's syndrome 885886 221406991 2008-06-24T11:00:37Z Dono 748890 /* Eponym */ {{refimprove|date=September 2006}} {{Infobox_Disease |Name=&nbsp; |Image= |Caption= |DiseasesDB=33254 |ICD10= |ICD9={{ICD9|576.2}} |ICDO= |OMIM= |MedlinePlus= |eMedicineSubj=radio |eMedicineTopic=451 |MeshID= }} '''Mirizzi's syndrome''' is a rare cause of acquired [[jaundice]]. It is caused by chronic [[cholecystitis]] and large [[gallstone]]s resulting in stenosis of the [[common hepatic duct]]. ==Epidemiology== Occurs in approximately 0.1% of patients with [[gallstone]] disease<ref name="hazzan1999">{{cite journal |last=Hazzan |first=D |coauthors=D Golijanin, P Reissman, SN Adler, E Shiloni |year=1999 |month=06 |title=Combined endoscopic and surgical management of Mirizzi syndrome |journal=Surgical Endoscopy |volume=13 |issue=6 |pages=618–20 |pmid=10347304 |accessdate=2007-12-09 |doi=10.1007/s004649901054}}</ref> and 0.7-1.4% of patients undergoing [[cholecystectomy]]<!--this should probably be Pemberton 1997, but I don't have the subscriptions--><ref name="ross2006">{{cite web |url=http://www.emedicine.com/radio/topic451.htm |title=Mirizzi syndrome |accessdate=2007-12-09 |last=Ross |first=Jeffrey W |coauthors=Gary S Sudakoff, Gregory B Snyder, Neela Lamki (editor), Bernard D Coombs (editor), Abraham H Dachman (editor), Robert M Krasny (editor), John Karani (editor) |date=2006-12-29 |work=[[eMedicine]] |publisher=[[WebMD]]}}</ref> It affects males and females equally, but tends to affect older people more often. There is no evidence of race having any bearing on the epidemiology. ==Pathophysiology== Multiple and large [[gallstone]]s can reside chronically in the [[Hartmann's pouch]] of the [[gallbladder]], causing [[inflammation]], [[necrosis]], scarring and ultimately [[fistula]] formation into the adjacent common bile duct (CBD). As a result, the CBD becomes obstructed by either scar or stone, resulting in [[jaundice]]. It can be divided into four types. Type I does not involve a fistula at all. Type II- IV involve fistulas of different sizes. Type II is classified as a fistula of <33%of the CBD width, Type III Mirizzi Syndrome involves a fistula between 33% and 66% of the CBD width, and Type IV involves a fistula of greater than 66% of the CBD width. ==Features== Mirizzi syndrome has no consistent or unique clinical features that distinguish it from other more common forms of obstructive jaundice. Symptoms of recurrent cholangitis, jaundice, right upper quadrant pain, and elevated [[bilirubin]] and [[alkaline phosphatase]] may or may not be present. Acute presentations of the syndrome include [[pancreatitis]] or [[cholecystitis]]. ==Diagnosis== [[CT scan]] or [[ultrasonography]] usually make the diagnosis. Often, [[ERCP]] is used to define the lesion anatomically prior to surgery. ==Treatment== The treatment of choice is surgical excision of the gallbladder, and reconstruction of the common hepatic duct and common bile duct. ==Eponym== It is named for Pablo Mirizzi, an Argentinean physician.<ref>{{WhoNamedIt|synd|3587}}</ref><ref>Mirizzi PL: Syndrome del conducto hepatico. J Int de Chir 1948; 8: 731-77</ref> ==References== {{Reflist}} {{Gastroenterology}} [[Category:Gastroenterology]] [[de:Mirizzi-Syndrom]] [[pl:Zespół Mirizziego]] [[pt:Síndrome de Mirizzi]]