DIAGNOSTIC AND THERAPEUTIC CHALLENGES OF MIRIZZI SYNDROME IN 28 PATIENTS IN GIT AND LIVER HOSPITAL IN MEDICAL CITY – BAGHDAD

Abstract

Background: Mirizzi syndrome (MS) occurs when gallstone impaction in Hartmann’s pouch results in extrinsic obstruction of the common bile duct, and fistulation may occur. Methods: prospective study of patients who are surgically treated for MS from January 2021 to march 2023.Patient presentations, diagnostic methods, treatments and complications were recorded. Results: twenty- eight patients were grouped according to a classification proposed by Beltran et al. 22 (78.5%), 5 (17.8%) and 1 (3.5 %) patients were classified as types I, II, and III respectively. Magnetic-resonance- cholangiopancreaticography was the most sensitive imaging modality, suggesting MS in (90 %), followed by CT scan (39.2%) and ultrasonography (14.2%). Twelve underwent Endoscopic-retrograde- cholangiopancreaticography and 8(66.6%) suggested the presence of MS. MS was accurately diagnosed pre-operatively in 20 (71.4%) patients. In type I, 21 (93.0%) patients underwent cholecystectomy and one patient underwent hepatico-enteric anastomosis. In type II, 3 (66.7%) underwent cholecystectomy and 1 (27.8%) required hepatico- enteric anastomosis and 1 underwent choledochoplasty the patient with type III MS, required a stone extraction and keeping of the choledocoenteric fistula Laparoscopic cholecystectomy was attempted in 8 (28.5%) patients and 6 (75.0%) required conversion. Conclusion: MS is a challenging condition and multimodal diagnostic approach has the greatest yield in achieving accurate pre-operative diagnosis. If suspicion is high, a trial of laparoscopic dissection with low threshold for open conversion is recommended.