BACKGROUND/AIMS: Mirizzi syndrome is a rare complication of longstanding gallstone disease which resulting in obstructive Jaundice. It is benign stricture of common hepatic duct because of stone impacted with in the cystic duct or Hartmann pouch of the gallbladder. The aim of this study is to evaluate our experience of Mirizzi syndrome and consider its surgical treatment. METHODS: During the years 1994 to 2001 at Asan medical center, 23 cases of Mirizzi syndrome were diagnosed on the basis of preoperative and postoperative findings and they were retrospectively reviewed. RESULTS: There were 12 patients with Csendes type I, 6 patients with type II, and 5 patients with Type III. Average age was 61 years (range: 31 to 83 years) For preoperative evaluation Endoscopic retrograde cholangiopancreatography (ERCP) and Ultrasonography were performed in all cases. Laparoscopic cholecystectomy was tried in 7 type I cases. 5 were successfully treated and 2 conversions were reported, all because of unclear anatomy. In 6 type II cases open cholecystrctomy, CHD repair and T tube insertion were performed. 5 patients with type III were required hepaticojejunostomy. CONCLUSIONS: High index of suspicion is required for diagnosis of Mirizzi syndrome and laparoscopic approach is permissible in specialized center especially in the case of suspected Mirizzi type I, under the recognition of biliary anatomy through preoperative imaging studies. If there is fistula or unclear anatomy, we recommend open operative techniques for the safety and the efficiency.
Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Chungcheongnam-do ; Constriction, Pathologic ; Cystic Duct ; Diagnosis ; Fistula ; Gallbladder ; Gallstones ; Hepatic Duct, Common ; Humans ; Jaundice, Obstructive ; Mirizzi Syndrome* ; Retrospective Studies ; Ultrasonography

Objective: Several factors contribute to the progression of complicated appendicitis (CA) in patients diagnosed with acute appendicitis. The goal of this study was to investigate whether the pelvic location of an appendix may be a new prehospital risk factor associated with CA. Methods: The study retrospectively reviewed 375 patients who underwent surgery for appendicitis from January 2013 to December 2013. Patients were divided into two groups: patients diagnosed with uncomplicated appendicitis (UA) and patients with CA. Demographics, clinical and laboratory findings, duration of symptoms, and the location of the appendix were evaluated. Univariate and multivariate statistical analyses identified risk factors leading to CA. Results: Of the 375 patients, 46 (12.3%) had CA. The univariate analysis confirmed that the patients diagnosed with CA had a higher body temperature (BT), longer duration of symptoms (DOS), and complained of left lower quadrant abdominal (LLQ) pain more frequently. Furthermore, compared to the UA group, the appendix was more frequently located in the pelvic region in the CA group. Multivariate analysis confirmed that BT >37.5°C (odds ratio [OR], 3.29; 95% confidence interval [CI], 1.64-6.61; P<0.01), LLQ pain (OR, 2.78; 95% CI, 1.16-6.69; P=0.02), DOS ≥48 hours (OR, 3.87; 95% CI, 1.94-7.71; P<0.01), and the pelvic location of appendix (OR, 3.18; 95% CI, 1.49-6.75; P<0.01) were risk factors for CA. Conclusion The pelvic location of an appendix may be a new prehospital risk factor associated with CA.

Objective: Several factors contribute to the progression of complicated appendicitis (CA) in patients diagnosed with acute appendicitis. The goal of this study was to investigate whether the pelvic location of an appendix may be a new prehospital risk factor associated with CA. Methods: The study retrospectively reviewed 375 patients who underwent surgery for appendicitis from January 2013 to December 2013. Patients were divided into two groups: patients diagnosed with uncomplicated appendicitis (UA) and patients with CA. Demographics, clinical and laboratory findings, duration of symptoms, and the location of the appendix were evaluated. Univariate and multivariate statistical analyses identified risk factors leading to CA. Results: Of the 375 patients, 46 (12.3%) had CA. The univariate analysis confirmed that the patients diagnosed with CA had a higher body temperature (BT), longer duration of symptoms (DOS), and complained of left lower quadrant abdominal (LLQ) pain more frequently. Furthermore, compared to the UA group, the appendix was more frequently located in the pelvic region in the CA group. Multivariate analysis confirmed that BT >37.5°C (odds ratio [OR], 3.29; 95% confidence interval [CI], 1.64-6.61; P<0.01), LLQ pain (OR, 2.78; 95% CI, 1.16-6.69; P=0.02), DOS ≥48 hours (OR, 3.87; 95% CI, 1.94-7.71; P<0.01), and the pelvic location of appendix (OR, 3.18; 95% CI, 1.49-6.75; P<0.01) were risk factors for CA. Conclusion The pelvic location of an appendix may be a new prehospital risk factor associated with CA.