Background/aims: Mirizzi syndrome is a rare benign complication of long-standing cholelithiasis and neither diagnostic modality nor clinical feature has a 100% sensitivity and specificity. The objective of our study was to call attention to the importance of this rare syndrome with its miscellaneous treatments.
Methodology: Between January 1992 and June 1997, a total of 8 (4 females and 4 males) patients, who were operated and diagnosed as Mirizzi syndrome, were retrospectively evaluated.
Results: The mean age was 53.75 years. During the same time period 0.98% of the total 812 cholelithiasis patients were Mirizzi syndrome. The ultrasound was used in 7, computed tomography (CT) in 4 and endoscopic retrograde cholangiopancreatography (ERCP) in 2 cases. Ultrasound allowed the detection of cholelithiasis in all, but proximal bile duct dilatation in only 71% of cases. CT detected the non-specific findings of syndrome in 75% of cases. In 2 patients, because of the difficulties due to the patients themselves and the technical management problems. ERCP could not detect the pathology properly. In 2 of 5 type I patients, we performed only cholecystectomy and in another 2 cholecystectomy plus T-tube drainage. In 1 case, due to major hepatic duct injury during surgery, cholecystectomy plus hepaticojejunostomy over the Y-stent was performed. Biliary fistula developed in 1 patient with T-tube drainage and was successfully managed with conservative treatment. In all type II patients we preferred cholecystectomy plus choledochoduodenostomy and all of them were free of complications.
Conclusions: If there is no question about the security of the common bile duct at surgery in type I patients, we recommended cholecystectomy, otherwise cholecystectomy plus exploration of common bile duct and/or drainage should be the procedure of choice. However, in type II patients cholecystectomy plus choledochoduodenostomy is a safe and effective procedure to perform.