Mirizzi Syndrome involves an impacted gallstone in the neck of the gallbladder or cystic duct with jaundice. It can be classified based on the anatomy and presence or absence of a fistula.
The jaundice is due to extrinsic compression of the common bile duct by the impacted stone associated with inflammation.
Site of Stone Impaction
in a long cystic duct running parallel to the common bile duct
in cystic duct or Hartmann's pouch
protrudes into the hepatic duct through the fistula
Management of Type I lesions:
(1) for Type IA lesion, cholecystectomy with closure of the cystic duct
(2) for Type IB lesions, cholecystectomy and choledochoplasty with a 5 mm cuff from the gallbladder.
Management of Type II lesions (Shah et al):
(1) If the fistula is large (> 2/3 of common bile duct diameter) or the common bile duct is extensively damaged, then a Roux-en-Y anastomosis is made with the jejunum.
(2) If the fistula is from 1/3 to 2/3 of the common bile duct diameter then a choledochoplasty is performed with a 10 mm cuff from the gallbladder.
(3) If the fistula is less than 1/3 of the common bile duct diameter, then a choledochoplasty is performed with a 5 mm cuff from the gallbladder.
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Specialty: Gastroenterology, Surgery, general