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Bohanon FJ, Mao RMD, Williams TP, Bourgeois DP, Field SB, Radhakrishnan RS, Sanfiel FJ. Rare Case of a Combined Cholecystocolonic and Cholecystoduodenal Fistula Presenting With Pneumobilia. Case Rep Surg 2024; 2024:1084775. [PMID: 39398299 PMCID: PMC11469931 DOI: 10.1155/2024/1084775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/21/2024] [Accepted: 08/30/2024] [Indexed: 10/15/2024] Open
Abstract
Background: Cholecystoenteric fistulae are rare complications of gallstone disease, with a reported incidence of 0.5% to 0.9% of cholecystectomies. Cholecystoduodenal is the most common fistula followed by cholecystocolonic fistulae. Summary: We report a case of pneumobilia resulting from a combined cholecystoduodenal and cholecystocolonic fistulae treated with a laparoscopic subtotal cholecystectomy and open repair of the enteric fistulae. Conclusion: Combined cholecystoduodenal and cholecystocolonic fistulae are an extremely rare complication of gallstone disease, and meticulous preoperative planning and operative dexterity are needed to safely manage these unusual fistulae.
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Affiliation(s)
- Fredrick J. Bohanon
- Lane Regional Medical Center, Lane Surgery Group, 6300 Main Street, Zachary, Louisiana 70791, USA
| | - Rui-Min D. Mao
- Department of Surgery, University of Texas Medical Branch-Galveston, 301 University Boulevard Galveston, Galveston, Texas 77555, USA
| | - Taylor P. Williams
- Department of Surgery, University of Texas Medical Branch-Galveston, 301 University Boulevard Galveston, Galveston, Texas 77555, USA
| | - Danny P. Bourgeois
- Lane Regional Medical Center, Lane Surgery Group, 6300 Main Street, Zachary, Louisiana 70791, USA
| | - Samuel B. Field
- Lane Regional Medical Center, Lane Surgery Group, 6300 Main Street, Zachary, Louisiana 70791, USA
| | - Ravi S. Radhakrishnan
- Department of Surgery, University of Texas Medical Branch-Galveston, 301 University Boulevard Galveston, Galveston, Texas 77555, USA
| | - Francisco J. Sanfiel
- Lane Regional Medical Center, Lane Surgery Group, 6300 Main Street, Zachary, Louisiana 70791, USA
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Sah R, Rawal SB, Malla S, Rayamajhi J, Bhat PS. Cholecystocutaneous fistula after cholecystectomy. J Surg Case Rep 2024; 2024:rjae617. [PMID: 39372394 PMCID: PMC11451475 DOI: 10.1093/jscr/rjae617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Revised: 09/03/2024] [Accepted: 09/20/2024] [Indexed: 10/08/2024] Open
Abstract
Cholecystocutaneous fistula is an exceedingly rare type of external biliary fistula, where an abnormal connection forms between the gallbladder and the skin. Cholecystocutaneous fistula commonly develops in the setting of chronic calculus cholecystitis or following a previous surgical intervention involving the biliary tract. Patients with cholecystocutaneous fistula often present with systemic symptoms, such as fever, nausea, and vomiting, as well as localized symptoms in the right upper quadrant of the abdomen, where the external opening of the fistula is typically found. Ultrasonography, computed tomography, magnetic resonance imaging, magnetic resonance cholangiopancreatography (MRCP), and fistulograms (computed tomography or X-ray) are commonly used. Computed tomography has proven to be more effective than ultrasonography in delineating the fistulous tract and the associated fluid collections. Open cholecystectomy with excision of the fistulous tract is considered the gold standard and is curative in the majority of cases. However, a laparoscopic approach has become a viable alternative, especially in the hands of experienced surgeons.
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Affiliation(s)
- Raju Sah
- Surgical Gastroenterology Department, Nepal Mediciti Hospital, Karyabinayak, Lalitpur 44600, Nepal
| | - Sushil Bahadur Rawal
- Surgical Gastroenterology Department, Nepal Mediciti Hospital, Karyabinayak, Lalitpur 44600, Nepal
| | - Srijan Malla
- Surgical Gastroenterology Department, Nepal Mediciti Hospital, Karyabinayak, Lalitpur 44600, Nepal
| | - Jyoti Rayamajhi
- Surgical Gastroenterology Department, Nepal Mediciti Hospital, Karyabinayak, Lalitpur 44600, Nepal
| | - Pawan Singh Bhat
- Surgical Gastroenterology Department, Nepal Mediciti Hospital, Karyabinayak, Lalitpur 44600, Nepal
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Hua L, Bull N, Fox A. Totally endoscopic management of type III Mirizzi syndrome using spyglass cholangioscopy. ANZ J Surg 2023; 93:2014-2016. [PMID: 37243315 DOI: 10.1111/ans.18545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 05/14/2023] [Accepted: 05/18/2023] [Indexed: 05/28/2023]
Affiliation(s)
- Lina Hua
- Department of UGI and HPB Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Nicholas Bull
- Department of UGI and HPB Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
| | - Adrian Fox
- Department of UGI and HPB Surgery, Box Hill Hospital, Melbourne, Victoria, Australia
- HPB and UGI Surgery, St Vincent's Hospital, Melbourne, Victoria, Australia
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Wu CH, Liu NJ, Yeh CN, Wang SY, Jan YY. Predicting cholecystocholedochal fistulas in patients with Mirizzi syndrome undergoing endoscopic retrograde cholangiopancreatography. World J Gastroenterol 2020; 26:6241-6249. [PMID: 33177796 PMCID: PMC7596637 DOI: 10.3748/wjg.v26.i40.6241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/09/2020] [Accepted: 10/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Mirizzi syndrome (MS) is defined as an extrinsic compression of the extrahepatic biliary system by an impacted stone in the gallbladder or the cystic duct leading to obstructive jaundice. Endoscopic retrograde cholangiopancreatography (ERCP) could serve diagnostic and therapeutic purposes in patients with MS in addition to revealing the relationships between the cystic duct, the gallbladder, and the common bile duct (CBD). Cholecystectomy is a challenging procedure for a laparoscopic surgeon in patients with MS, and the presence of a cholecystocholedochal fistula renders preoperative diagnosis important during ERCP.
AIM To evaluate cholecystocholedochal fistulas in patients with MS during ERCP before cholecystectomy.
METHODS From 2004 to 2018, all patients diagnosed with MS during ERCP were enrolled in this study. Patients with associated malignancy or those who had already undergone cholecystectomy before ERCP were excluded. In total, 117 patients with MS diagnosed by ERCP were enrolled in this study. Among them, 21 patients with MS had cholecystocholedochal fistulas. MS was further confirmed during cholecystectomy to check if cholecystocholedochal fistulas were present. The clinical data, cholangiography, and endoscopic findings during ERCP were recorded and analyzed.
RESULTS Gallbladder opacification on cholangiography is more frequent in patients with MS complicated by cholecystocholedochal fistulas (P < 0.001). Pus in the CBD and stricture length of the CBD longer than 2 cm were two additional independent factors associated with MS, as demonstrated by multivariate analysis (odds ratio 5.82, P = 0.002; 0.12, P = 0.008, respectively).
CONCLUSION Gall bladder opacification is commonly seen in patients with MS with cholecystocholedochal fistulas during pre-operative ERCP. Additional findings such as pus in the CBD and stricture length of the CBD longer than 2 cm may aid the diagnosis of MS with cholecystocholedochal fistulas.
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Affiliation(s)
- Chi-Huan Wu
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan 333, Taiwan
| | - Nai-Jen Liu
- Department of Gastroenterology and Hepatology, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan 333, Taiwan
| | - Chun-Nan Yeh
- Department of General Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan 333, Taiwan
| | - Shang-Yu Wang
- Department of General Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan 333, Taiwan
| | - Yi-Yin Jan
- Department of General Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan 333, Taiwan
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Brimo Alsaman MZ, Mazketly M, Ziadeh M, Aleter O, Ghazal A. Cholecystocutaneous fistula incidence, Etiology, Clinical Manifestations, Diagnosis and treatment. A literature review. Ann Med Surg (Lond) 2020; 59:180-185. [PMID: 33082947 PMCID: PMC7554209 DOI: 10.1016/j.amsu.2020.09.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 01/18/2023] Open
Abstract
Cholecystocutaneous Fistula (CCF) is a type of external biliary fistula, which connects the gallbladder with the skin. Thilesus first described this phenomenon in 1670. There is usually a history of calculi in the gallbladder or neglected gallbladder disease. The incidence of CCF is rare, most patients are elderly females with the mean age of 72.8 years old. They usually present with chronic calculus cholecystitis or a history of a previous surgical intervention. US, CT, MRI, MRCP and (CT or X-ray) fistulogram are used to confirm the diagnosis. CT was more significant than US in identifying the track of the fistula and the fluid that runs throw it. CCF patients presented with systemic symptoms (fever, nausea and vomiting) or local symptoms. RUQ region is the most common site of external opening. Open cholecystectomy with excision of the fistulous tract is considered an acceptable option for treatment and it is curative in most cases. However, laparoscopic approach can be another option with experience surgeons.
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Affiliation(s)
| | | | | | - Owais Aleter
- Department of Radiology, Aleppo University Hospital, Aleppo, Syria
| | - Ahmad Ghazal
- Department of Surgery, Aleppo University Hospital, Syria
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Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era. Gastroenterol Res Pract 2015; 2016:6293538. [PMID: 26819608 PMCID: PMC4706943 DOI: 10.1155/2016/6293538] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/23/2015] [Indexed: 12/17/2022] Open
Abstract
Biliary fistulas are rare complications of gallstone. They can affect either the biliary or the gastrointestinal tract and are usually classified as primary or secondary. The primary fistulas are related to the biliary lithiasis, while the secondary ones are related to surgical complications. Laparoscopic surgery is a therapeutic option for the treatment of primary biliary fistulas. However, it could be the first responsible for the development of secondary biliary fistulas. An accurate preoperative diagnosis together with an experienced surgeon on the hepatobiliary surgery is necessary to deal with biliary fistulas. Cholecystectomy with a choledocoplasty is the most frequent treatment of primary fistulas, whereas the bile duct drainage or the endoscopic stenting is the best choice in case of minor iatrogenic bile duct injuries. Roux-en-Y hepaticojejunostomy is the extreme therapeutic option for both conditions. The sepsis, the level of the bile duct damage, and the involvement of the gastrointestinal tract increase the complexity of the operation and affect early and late results.
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7
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Abstract
Extrinsic compression of the bile duct from gallstone disease is associated with bilio-biliary fistulization, requiring biliary-enteric reconstruction. Biliary-enteric fistulas are associated with intestinal obstruction at various levels. The primary goal of therapy is relief of intestinal obstruction; definitive repair is performed for selected patients. Hemobilia from gallstone-related pseudoaneurysms is preferentially controlled by selective arterial embolization. Rapidly increasing jaundice with relatively normal liver enzymes is a diagnostic hallmark of bilhemia. Acquired thoraco-biliary fistulas are primarily treated by percutaneous and endoscopic interventions.
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Affiliation(s)
- Minh B Luu
- Department of General Surgery, Rush University Medical Center, Rush Medical College, 1633 West Congress Parkway, Chicago, IL 60612, USA.
| | - Daniel J Deziel
- Department of General Surgery, Rush University Medical Center, Rush Medical College, 1633 West Congress Parkway, Chicago, IL 60612, USA
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Beltrán MA. Mirizzi syndrome: History, current knowledge and proposal of a simplified classification. World J Gastroenterol 2012; 18:4639-50. [PMID: 23002333 PMCID: PMC3442202 DOI: 10.3748/wjg.v18.i34.4639] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 03/16/2012] [Accepted: 03/20/2012] [Indexed: 02/06/2023] Open
Abstract
Chronic complications of symptomatic gallstone disease, such as Mirizzi syndrome, are rare in Western developed countries with an incidence of less than 1% a year. The importance and implications of this condition are related to their associated and potentially serious surgical complications such as bile duct injury, and to its modern management when encountered during laparoscopic cholecystectomy. The pathophysiological process leading to the subtypes of Mirizzi syndrome has been explained by means of a pressure ulcer caused by an impacted gallstone at the gallbladder infundibulum, leading to an inflammatory response causing first external obstruction of the bile duct, and eventually eroding into the bile duct and evolving to a cholecystocholedochal or cholecystohepatic fistula. This article reviews the life of Pablo Luis Mirizzi, describes the earlier and later descriptions of Mirizzi syndrome, discusses the pathophysiological process leading to the development of these uncommon fistulas, reviews the current diagnostic modalities and surgical approaches and finally proposes a simplified classification for Mirizzi syndrome intended to standardize the reports on this condition and to eventually develop a consensual surgical approach to this unexpected and seriously dangerous condition.
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Abstract
Mirizzi syndrome is an important complication of gallstone disease. If not recognized preoperatively, it can result in significant morbidity and mortality. Preoperative diagnosis may be difficult despite the availability of multiple imaging modalities. Ultrasonography (US), CT, and magnetic resonance cholangiopancreatography (MRCP) are common initial tests for suspected Mirizzi syndrome. Typical findings on US suggestive of Mirizzi syndrome are a shrunken gallbladder, impacted stone(s) in the cystic duct, a dilated intrahepatic tree, and common hepatic duct with a normal-sized common bile duct. The main role of CT is to differentiate Mirizzi syndrome from a malignancy in the area of porta hepatis or in the liver. MRI and MRCP are increasingly playing an important role and have the additional advantage of showing the extent of inflammation around the gallbladder that can help in the differentiation of Mirizzi syndrome from other gallbladder pathologies such as gallbladder malignancy. Endoscopic retrograde cholangiopancreatography (ERCP) is the gold standard in the diagnosis of Mirizzi syndrome. It delineates the cause, level, and extent of biliary obstruction, as well as ductal abnormalities, including fistula. ERCP also offers a variety of therapeutic options, such as stone extraction and biliary stent placement. Percutaneous cholangiogram can provide information similar to ERCP; however, ERCP has an additional advantage of identifying a low-lying cystic duct that may be missed on percutaneous cholangiogram. Wire-guided intraductal US can provide high-resolution images of the biliary tract and adjacent structures. Treatment is primarily surgical. Open surgery is the current standard for managing patients with Mirizzi syndrome. Good short- and long-term results with low mortality and morbidity have been reported with open surgical management. Laparoscopic management is contraindicated in many patients because of the increased risk of morbidity and mortality associated with this approach. Endoscopic treatment may serve as an alternative in patients who are poor surgical candidates, such as elderly patients or those with multiple comorbidities. Endoscopic treatment also can serve as a temporizing measure to provide biliary drainage in preparation for an elective surgery.
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Abstract
Abstract
The authors have analyzed the problem of Mirizzi syndrome (MS) and found in the literature that it was reported in 0.3% to 3% of patients undergoing cholecystectomy. Anatomic disorder, especially the presence of cholecystocholedochal fistula, increases the risk of bile duct injury during cholecystectomy, albeit more often during laparoscopic than laparotomic cholecystectomy. A comparative study was performed regarding the incidence of MS in two groups of patients: 332 patients in Zrenjanin in the year 2009, and 531 patients in Belgrade in the year 2005, with an incidence of MS found in 2 patients in Zrenjanin (0.63%) and 4 patients in Belgrade (0.75%). The incidence rate was 6% in Zrenjanin and 7.5% in Belgrade, but there was no statistically significant difference between the two groups. All patients with MS were diagnosed during the operative period using operative cholangiography. During preoperative diagnosis, patients underwent laboratory ultrasound examination, and those who were suspected of having an anatomic disorder underwent operative cholangiography, although patients today more often undergo choledochoscopy then cholangiography. MS according to classification by Csendes was found in all 6 patients undergoing operation.
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Ahlawat SK, Singhania R. A Case of Type IV Cholecystobiliary Fistula. Gastroenterol Hepatol (N Y) 2008; 4:873-874. [PMID: 21904477 PMCID: PMC3093690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Sushil K. Ahlawat
- Division of Gastroenterology and Hepatology, University of Medicine and Dentistry New Jersey–New Jersey Medical School, Newark, New Jersey
| | - Rohit Singhania
- Department of Internal Medicine, Jacobi Hospital, New York, New York
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12
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Csendes A. Review. Gastroenterol Hepatol (N Y) 2008; 4:875-876. [PMID: 21904478 PMCID: PMC3093691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Attila Csendes
- Department of Surgery, Clinical Hospital University of Chile, Santiago, Chile
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Ibrarullah M, Mishra T, Das AP. Mirizzi syndrome. Indian J Surg 2008; 70:281-7. [PMID: 23133085 PMCID: PMC3452351 DOI: 10.1007/s12262-008-0084-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 11/04/2008] [Indexed: 12/20/2022] Open
Abstract
Mirizzi syndrome is a complication of long standing cholelithiasis. In this, obstruction of the extrahepatic bile duct by stone/s in the Hartman's pouch or cystic duct (Mirrizi type I) may erode in to the bile duct forming cholecystobiliary fistula (Mirrizi type II). Altered biliary tract anatomy and the associated pathology make cholecystectomy, open or laparoscopic, a formidable undertaking. Awareness of this entity and its preoperative diagnosis is of paramount importance to avoid injury to the bile duct at surgery. Improper surgical procedures may lead to long-term stricture formation. The present article reviews the available literature on various aspect of this syndrome including its pathogenesis, diagnosis and recommended management guidelines.
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Affiliation(s)
- Md. Ibrarullah
- Dept of Surgery & Surgical Gastroenterology, Hi-tech Medical College & Hospital, Bhubaneswar, 751 010 Orissa India
| | - Tapas Mishra
- Dept of Surgery & Surgical Gastroenterology, Hi-tech Medical College & Hospital, Bhubaneswar, 751 010 Orissa India
| | - A. P. Das
- Dept of Surgery & Surgical Gastroenterology, Hi-tech Medical College & Hospital, Bhubaneswar, 751 010 Orissa India
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A Solis-Caxaj C, Ramanah R, Miguet M, Traverse G, Koch S. [Mirizzi syndrome type II with a gastric antrum erosion: an atypical presentation]. ACTA ACUST UNITED AC 2008; 31:1020-3. [PMID: 18166899 DOI: 10.1016/s0399-8320(07)78324-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Mirizzi's syndrome is an unusual complication of long-standing gallstone disease that occurs in 0.7% to 1.4% of all cholecystectomies performed. It was originally described as an obstruction of the proximal bile duct secondary to external compression by a large stone located in the Hartmann pouch or secondary to local inflammatory changes. In recent years, extension of Mirizzi's eponym has been used to define obstructive jaundice induced by different grades of compression and erosion of the bile duct wall by a stone, which can evolve to a complete cholecystocholedocal fistula, with compression and dilatation of the proximal bile duct by the stone. Herein we present a case of Mirizzi's syndrome type II with a gastric antrum erosion associated, in highlighting the essential of the pre-operative diagnosis by endoscopic retrograde cholangiography (ERC) or MR cholangiography, to avoid iatrogenic injuries of the bile ducts, because the syndrome has been cited as a trap in the surgery gallstones. This case is an example that the natural history of Mirizzi's syndrome cannot stop with the compression or the cholecysto-biliary fistula, but it may result in a complex fistula with the neighbouring digestive organs.
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KANEMAKI N, NAKAZAWA S, YAMAO K, YOSHINO J, INUI K, YAMACHIKA H, FUJIMOTO M, WAKABAYASHI T, OKUSHIMA K, HIRANO K, MIYOSHI H, TAKI N, SUGIYAMA K, FUJI A, HATTORI T. Application of Peroral Cholecystoscopy in a Case of Cholecystocolic Fistula. Dig Endosc 2007. [DOI: 10.1111/j.1443-1661.1995.tb00178.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- Naoto KANEMAKI
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Saburo NAKAZAWA
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Kenji YAMAO
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Junji YOSHINO
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Kazuo INUI
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Hitoshi YAMACHIKA
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Masao FUJIMOTO
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Takao WAKABAYASHI
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Kazumu OKUSHIMA
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Ken HIRANO
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Hironao MIYOSHI
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Norihito TAKI
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Kazuhisa SUGIYAMA
- *Department of Internal Medicine, Second Teaching Hospital, Fujita Health University, School of Medicine, Nagoya, Japan
| | - Akihiko FUJI
- **Department of Internal Medicine, Seirei Hospital, Nagoya, Japan
| | - Toshiyuki HATTORI
- ***Department of Internal Medicine, Yamashita Hospital, Aichi, Japan
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Abstract
BACKGROUND Mirizzi syndrome was reported in 0.3-3% of patients undergoing cholecystectomy. The distortion of anatomy and the presence of cholecystocholedochal fistula increase the risk of bile duct injury during cholecystectomy. METHODS A Medline search was undertaken to identify articles that were published from 1974 to 2004. Additional papers were identified by a manual search of the references from the key articles. RESULTS A preoperative diagnosis was made in 8-62.5% of cases. Open surgical treatment gave good short-term and long-term results. There was a lack of good data in laparoscopic treatment. Conversion to open surgery rates was high, and bile duct injury rate varied from 0 to 22.2%. CONCLUSION A high index of clinical suspicion is required to make a preoperative or intraoperative diagnosis, which leads to good surgical planning to treat the condition. Open surgery is the gold standard. Mirizzi syndrome should still be considered as a contraindication for laparoscopic surgery.
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Affiliation(s)
- Eric C Lai
- Department of Surgery, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
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18
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Al-Akeely MHA, Alam MK, Bismar HA, Khalid K, Al-Teimi I, Al-Dossary NF. Mirizzi syndrome: ten years experience from a teaching hospital in Riyadh. World J Surg 2006; 29:1687-92. [PMID: 16311870 DOI: 10.1007/s00268-005-0100-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Mirizzi syndrome (MS) is an uncommon presentation of cholelithiasis. This study aims to find the incidence and analyze the outcome of management of this condition at Riyadh Medical Complex (RMC) with particular reference to diagnostic methods and outcome of surgical treatment. METHODS Retrospective study on 17 consecutive patients of MS diagnosed and managed at RMC over ten year period. The records were reviewed for demography, clinical presentation, diagnostic methods, operative procedures, postoperative complication and follow up. RESULTS The incidence of MS syndrome was 0.7% of 2415 cholecystectomies. There was preponderance of Type I variety (58.8%). Ultrasonography was able to diagnose 82% cases. ERCP suggested the diagnosis in all cases and helped further in classifying and management of these patients. All Type I cases were managed with partial cholecystectomy, two underwent laparoscopic surgery. Three Type II patients were managed by partial cholecystectomy alone. Three patients with Type III variety had choledochoplasty whereas one remaining patient with Type IV variety underwent hepatico-jejunostomy. All patients had complete recovery with 17.6% procedure-related morbidity and no hospital mortality. All patients are doing well over a mean follow up 6.5 years. CONCLUSION Preoperative diagnosis of Mirizzi syndrome by ultrasound and ERCP is essential to prevent serious complications during surgery. Partial cholecystectomy is an adequate procedure for Types I & II MS. Choledochoplasty provides an effective surgical repair in Type III cases. Although laparoscopic cholecystectomy in MS may be hazardous, it may still be tried in preoperatively diagnosed type I cases, provided the surgeon is experienced and keeps a low threshold for conversion open surgery.
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Affiliation(s)
- Mohammed H A Al-Akeely
- Department of General Surgery, College of Medicine, King Saud University, P.O. Box 2925, Riyadh, 11461, Kingdom of Saudi Arabia
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Beltran MA, Csendes A. Mirizzi syndrome and gallstone ileus: an unusual presentation of gallstone disease. J Gastrointest Surg 2005; 9:686-9. [PMID: 15862264 DOI: 10.1016/j.gassur.2004.09.058] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2004] [Accepted: 09/21/2004] [Indexed: 01/31/2023]
Abstract
We discuss the case of a man with an unusual complication of gallstone disease. An 85-year-old patient presented to the emergency department with a 3-week history of abdominal pain in the right upper abdominal quadrant. Thoracoabdominal radiography demonstrated that the whole extrahepatic biliary tree, including the common bile duct, common hepatic duct, gallbladder, and left and right hepatic ducts, were visibly delineated by air. The operative findings revealed a small shrunken gallbladder, a fistula between the gallbladder fundus and the gastric antrum, and a cholecystohepatic fistula, corresponding to Mirizzi syndrome, type II. A large gallstone was found impacted in the jejunum. This patient seems to have developed initially a cholecystohepatic fistula. Due to the acute inflammatory process, the stone eroded through the gallbladder wall and into the gastric antrum, passing from the antrum into the small bowel, where it became impacted. We suggest that the natural history of Mirizzi syndrome does not end with a cholecystobiliary fistula but that the continuous inflammation in the triangle of Calot may result in a complex fistula involving not only the biliary tract but also the adjacent viscera.
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Affiliation(s)
- Marcelo A Beltran
- Department of Surgery, Emergency Unit, Hospital de Ovalle, Ovalle, Chile.
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Abou-Saif A, Al-Kawas FH. Complications of gallstone disease: Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus. Am J Gastroenterol 2002; 97:249-54. [PMID: 11866258 DOI: 10.1111/j.1572-0241.2002.05451.x] [Citation(s) in RCA: 165] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Gallstone is a common disease with a 10% prevalence in the United States and Western Europe. However, it is only symptomatic in 20-30% of patients, with biliary pain "colic" being the most common symptom. Complications of asymptomatic gallstone disease are generally rare, with an incidence of <1 %/yr. The most common complications of gallstone disease are acute cholecystitis, acute pancreatitis, ascending cholangitis, and gangrenous gallbladder. Less frequent complications include Mirizzi syndrome, cholecystocholedochal fistula, and gallstone ileus. Mirizzi syndrome and cholecystocholedochal fistula are two manifestations of the same process that starts with impaction of a gallstone in the gallbladder neck that results in obstruction of the bile duct, causing jaundice. The gallstone may erode into the bile duct, causing cholecystocholedochal fistula. Gallstone ileus refers to small bowel obstruction resulting from the impaction of one or more gallstones after they have migrated through a cholecystoenteric fistula. An accurate diagnosis is essential to the management and prevention of further complications. A variety of imaging and endoscopic modalities are used to make the diagnosis once the condition is suspected clinically. Treatment should be tailored to each individual patient. Management choices include ERCP, lithotripsy (endoscopic or extracorporeal), and surgery. Prognosis is frequently related to early recognition, management of any comorbid conditions, and careful selection of treatment modalities.
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Affiliation(s)
- Alaa Abou-Saif
- Division of Gastroenterology, Georgetown University Medical Center, Washington, District of Columbia 20007, USA
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PITMAN RG, DAVIES A. The clinical and radiological features of spontaneous internal biliary fistulae. Br J Surg 1998; 50:414-25. [PMID: 13943829 DOI: 10.1002/bjs.18005022212] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Gentileschi P, Forlini A, Rossi P, Bacaro D, Zoffoli M, Gentileschi E. Laparoscopic approach to cholecystocolic fistula: report of a case. JOURNAL OF LAPAROENDOSCOPIC SURGERY 1995; 5:413-7. [PMID: 8746996 DOI: 10.1089/lps.1995.5.413] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
The development of a fistulous tract from the gallbladder is associated with gallstones in 90% of cases. Cholecystocolic fistula (CCF) accounts for 10 to 20% of all enteric biliary fistulas. The conventional treatment advocated is cholecystectomy and closure of the fistulous communication. In this report a case of a patient whose only complaint was severe diarrhea is described. CCF was demonstrated by barium enema. The patient was treated by laparoscopic surgery. The case history and laparoscopic approach to enteric biliary fistula are described.
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Affiliation(s)
- P Gentileschi
- Department of General Surgery-University of Rome, Tor Vergata, Columbus Hospital, Italy
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Sakurai Y, Itoh M, Tsuchiya H, Ikegami F, Takasu S, Izumi T, Sinn S. Acute cholecystocolic fistula detected by colonoscopy. Gastrointest Endosc 1990; 36:163-4. [PMID: 2335293 DOI: 10.1016/s0016-5107(90)70987-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Csendes A, Díaz JC, Burdiles P, Maluenda F, Nava O. Mirizzi syndrome and cholecystobiliary fistula: a unifying classification. Br J Surg 1989; 76:1139-43. [PMID: 2597969 DOI: 10.1002/bjs.1800761110] [Citation(s) in RCA: 198] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A new classification of patients with Mirizzi syndrome and cholecystobiliary fistula is presented. Type I lesions are those with external compression of the common bile duct. In type II lesions a cholecystobiliary fistula is present with erosion of less than one-third of the circumference of the bile duct. In type III lesions the fistula involves up to two-thirds of the duct circumference and in type IV lesions there is complete destruction of the bile duct. A total of 219 patients were identified with these lesions from 17,395 patients with benign biliary tract diseases undergoing surgery. The incidence of type I lesions was 11 per cent, type II 41 per cent, type III 44 per cent and type IV 4 per cent. The majority had obstructive jaundice. In type I lesions, cholecystectomy plus choledochostomy is effective. In type II lesions, suture of the fistula with absorbable material or choledochoplasty with the remnant of gallbladder can be performed. In type III lesions suture is not indicated and choledochoplasty is recommended. In type IV lesions, bilioenteric anastomosis is preferred. Operative mortality rate increases according to the severity of the lesion, as does postoperative morbidity. During cholecystectomy, partial resection is recommended in order to extract the stones, visualize the common bile duct and define the type and location of the fistula. T tubes should be placed distal to the fistula.
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Affiliation(s)
- A Csendes
- Department of Surgery, University of Chile, Santiago, South America
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Sarr MG, Shepard AJ, Zuidema GD. Choledochoduodenal fistula: an unusual complication of duodenal ulcer disease. Am J Surg 1981; 141:736-40. [PMID: 7246867 DOI: 10.1016/0002-9610(81)90090-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Doromal NM, Estacio R, Sherman H. Cholecysto-duodeno-colic fistula with gallstone ileus: report of a case. Dis Colon Rectum 1975; 18:702-5. [PMID: 1192919 DOI: 10.1007/bf02604281] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Shah M, Mori W. A clinico-pathological study of spontaneous internal biliary fistula. ACTA PATHOLOGICA JAPONICA 1973; 23:349-58. [PMID: 4800537 DOI: 10.1111/j.1440-1827.1973.tb00797.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Piedad OH, Wels PB. Spontaneous internal biliary fistula, obstructive and nonobstructive types: twenty-year review of 55 cases. Ann Surg 1972; 175:75-80. [PMID: 5060861 PMCID: PMC1355161 DOI: 10.1097/00000658-197201000-00013] [Citation(s) in RCA: 46] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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31
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Shartsis J, Dinan JT. Benign cholecystogastroduodenocolic fistula. THE AMERICAN JOURNAL OF DIGESTIVE DISEASES 1969; 14:424-9. [PMID: 5787593 DOI: 10.1007/bf02239363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Constant E, Turcotte JG. Choledochoduodenal fistula: the natural history and management of an unusual complication of peptic ulcer disease. Ann Surg 1968; 167:220-8. [PMID: 5635704 PMCID: PMC1387407 DOI: 10.1097/00000658-196802000-00010] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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McEwan-Alvarado G, Dysart DN. Choledochoduodenal fistulas complicating duodenal ulcer. THE AMERICAN JOURNAL OF DIGESTIVE DISEASES 1967; 12:947-54. [PMID: 6039575 DOI: 10.1007/bf02236453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Williams GD, Hara M. Spontaneous choledochogastric fistula. Report of the first successful surgical repair. Am J Surg 1966; 112:102-5. [PMID: 5936635 DOI: 10.1016/s0002-9610(66)91142-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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ROGERS FA, CARTER R. GALLSTONE INTESTINAL OBSTRUCTION. Calif Med 1958; 88:140-3. [PMID: 13500219 PMCID: PMC1512579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
The literature on the subject and the records of 40 cases of proven gallstone obstruction in the small intestine observed at the Los Angeles County General Hospital over a 27-year period were reviewed. The incidence of this type of obstruction is about 1.5 per cent of all cases of mechanical intestinal obstruction; and it occurs more often in women than in men-the ratio was 3.7 to 1 in the Los Angeles County General Hospital series. In general, the majority of patients are in the seventh decade of life, although in the present series the age average was well over 70 years. Gallstones large enough to cause intestinal obstruction almost invariably reach the intestinal tract through a fistula between the gallbladder and the duodenum. The symptoms of gallstone obstruction are principally those of mechanical obstruction of the small bowel. The usual site of obstruction is the distal ileum. When gallstones are the cause of obstruction, the symptoms may be intermittent. Surgical operation is the treatment of choice. Exploration should include a complete examination of the intestinal tract to make certain multiple stones are not overlooked, and the right upper quadrant should be palpated for the presence of an acutely inflamed gallbladder or more calculi.
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CRAIGHEAD CC, RAYMOND AH. With special reference to choledochoduodenal fistula complicating duodenal ulcer. Am J Surg 1954; 87:523-33. [PMID: 13138794 DOI: 10.1016/0002-9610(54)90414-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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HYMAN S, STEIGMANN F. Perforation of the gall bladder. THE AMERICAN JOURNAL OF DIGESTIVE DISEASES 1947; 14:221-226. [PMID: 20255372 DOI: 10.1007/bf03001059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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