We report a case of Mirizzi syndrome type II associated with biliary enteric fistula. It is important to identify this combination early, as it is associated with high morbidity. In our case, intraoperative findings were cholecystoduodenal fistula and communication of Hartmann’s pouch with common bile duct (CBD). A subtotal cholecystectomy with excision of cholecystoduodenal fistula was performed. A minimal surgical maneuver of Calot’s Triangle with repair of cholecystoduodenal fistula is required during the intraoperative period.
Intestinal Fistula ; Gallstones ; Mirizzi Syndrome

Mirizzi syndrome is commonly defined as a common hepatic duct obstruction caused by extrinsic compression from an impacted stone in the cystic duct. Mirizzi syndrome has traditionally been treated surgically. However, there are several case reports and small series describing endoscopic and percutaneous alternatives to open surgery. We encountered two cases of type I Mirizzi syndrome that was successfully treated endoscopically. We report these cases with a review of the relevant literature.
Cystic Duct ; Hepatic Duct, Common ; Mirizzi Syndrome*

Mirizzi's syndrome (MS) caused by the retention of a stone in the cystic duct stump after cholecystectomy is rare. Most cases of MS are treated by surgical intervention. However, developments of endoscopic accessories and techniques have resulted in the recent introduction of endoscopic treatments for MS. Furthermore, in view of the postoperative morbidity caused by post-operative scarring, the endoscopic approach should be preferred to the surgical approach. In the described case, the authors were able to remove a remnant cystic duct stone endoscopically because the cystic duct stump was wide and non-tortuous. This case shows endoscopic retrograde cholangiopancreatography with mechanical lithotripsy can be utilized in suitable cases of type I MS development after cholecystectomy.
Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy ; Cicatrix ; Cystic Duct ; Lithotripsy ; Mirizzi Syndrome*

Since multiport laparoscopic cholecystectomy has become a standard treatment for gallbladder (GB) disease, a single incision laparoscopic surgical technique has been tried to decrease the surgical site pain and achieve a better cosmetic out come in selected patients. The development of devices dedicated for single incision laparoscopic cholecystectomy (SILC) is expanding the indication of this single incision laparoscopic technique to more complicated GB diseases. Mirizzi syndrome (MS) is one of the complex uncommon gallstone diseases in patients undergoing cholecystectomy. Because the laparoscopic procedure has become a routine treatment for cholecystectomy, several studies have reported their experience with the laparoscopic technique for the treatment of MS with a comparable outcome in Csendes type I or II. Because the indication for SILC cholecystectomy is expanded to more complicated GB conditions, and the desire of patients for a less painful, better cosmetic surgical outcome has increased, our medical center used this single incision laparoscopic surgical technique for MS Csendes types I and II patients. Here, we report 2 successful cases of SILC for patients with MS types I and II without significant morbidity.
Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Gallbladder ; Gallstones ; Humans ; Mirizzi Syndrome

Mirizzi syndrom is a rare disorder characterized by obstruction of common hepatic duct due to impacted gallbladder neck or dystic duct stone and is an uncommon cause of obstructive jaundice. Authors experienced one case of Mirizzi syndrome mimicked lobulated intraductal tumor.
Gallbladder ; Hepatic Duct, Common ; Jaundice, Obstructive ; Mirizzi Syndrome ; Neck

Mirizzi syndrome is an uncommon cause of obstructive jaundice. It consists of the following elements: (1) an anatomic arrangement of the cystic duct such that it lies almost parallel to the common hepatic duct, (2) impaction of a gallstone in the cystic duct or neck of the gall bladder, (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. (continue...)
Cholangitis ; Cystic Duct ; Fibrosis ; Gallstones ; Hepatic Duct, Common ; Jaundice, Obstructive ; Mirizzi Syndrome* ; Neck ; Urinary Bladder

The advent of endoscopic retrograde cholangiopancreatography (ERCP) three decades ago had a dramatic impact on the treatment of common bile duct (CBD) stones. The advantages of ERCP over open surgery led to its widespread dissemination ad the predominant method of treating choledocholithiasis. After sphincterotomy, 85% to 90% of CBD stones can be removed with a Dormia basket or balloon catheter. These techniques are described as having both advantages and disadvantages. Methods for managing "difficult stones" include mechanical lithotripsy (ML), intraductal shock wave lithotripsy, such as electrohyhydroulic lthotripsy (EHL), laser-induced shock wave lithotripsy (LISL), extracoporeal shock wave lithotripsy, chemical dissolution, and biliary stenting. The local expertise and availability of equipment determines the choice of method used. In general, EHL or LISL is used for impacted CBD stones including stones in Mirizzi syndrome refractory to ML. ESWL is best suited for intrahepatic stones. Using currently bile duct stones still require surgical intervention.
Bile Ducts ; Catheters ; Cholangiopancreatography, Endoscopic Retrograde ; Choledocholithiasis ; Common Bile Duct ; Lithotripsy ; Mirizzi Syndrome ; Shock ; Stents

The remnant cystic duct or gallbladder neck calculus may rarely result in post-cholecystectomy Mirizzi syndrome. Various managements have been proposed for the treatment of post-cholecystectomy Mirizzi syndrome. Some previous cases of post-cholecystectomy Mirizzi syndrome have been managed with open cholecystectomy and endoscopically. We report a case of a laparoscopic stone removal of post-cholecystectomy Mirizzi syndrome that developed 7 months after laparoscopic cholecystectomy. To our knowledge, this is the first case of laparoscopic management of post-cholecystectomy Mirizzi syndrome. The mechanism, diagnosis and treatment of post-cholecystectomy Mirizzi syndrome are discussed.
Calculi ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cystic Duct ; Gallbladder ; Gallstones ; Mirizzi Syndrome ; Neck

Mirizzi syndrome refers to a gallstone impacted in the gallbladder neck and this exerts pressure on the adjacent common hepatic duct, which produces inflammatory stricture and eventual penetration of its lumen. Making the preoperative diagnosis of Mirrizzi syndrome is very important. But if it cannot be diagnosed before an operation, intraoperative recognition is also important for surgeons. We experienced two patients who were diagnosed with this syndrome at the time of operation.
Choledocholithiasis ; Constriction, Pathologic ; Gallbladder ; Gallstones ; Hepatic Duct, Common ; Humans ; Mirizzi Syndrome ; Neck

Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Common Bile Duct ; Humans ; Mirizzi Syndrome/surgery*