Type IV Mirizzi Syndrome at The Hepatic Confluence Mimicking a Hilar Cholangiocarcinoma

Mirizzi’s syndrome refers to common bile duct obstruction resulting from compression by a gallstone impacted in the cystic duct or neck of the gallbladder. Some cases can not be identified preoperatively, despite modern imaging techniques. Today, treatment of Mirizzi syndrome is surgical. The essential part of the management of patients with Mirizzi syndrome is to determine the best surgical procedure in the preoperative period. In type I patients, simple cholecystectomy is generally enough, but types II-IV require more complex surgical approach, such as cholecystectomy and bilioenteric anastomosis. Here, we presented a 48 year-old man with obstructive jaundice who diagnosed as Mirizzi’s syndrome.

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Mirizzi’s syndrome refers to common bile duct obstruction resulting from compression by a gallstone impacted in the cystic duct or neck of the gallbladder. Some cases can not be identified preoperatively, despite modern imaging techniques. Today, treatment of Mirizzi syndrome is surgical. The essential part of the management of patients with Mirizzi syndrome is to determine the best surgical procedure in the preoperative period. In type I patients, simple cholecystectomy is generally enough, but types IIIV require more complex surgical approach, such as cholecystectomy and bilioenteric anastomosis. Here, we presented a 48 year-old man with obstructive jaundice who diagnosed as Mirizzi’s syndrome

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  • Mithani R, Schwesinger WH, Bingener J, Sirinek KR, Gross GW. The mirizzi syndrome: multidisciplinary management Gastrointest Surg. 2008;12(6):1022-8. optimal outcomes. J
  • Mirizzi PL. Syndrome del conducto hepatico. J Int Chir. 1948;8:731-77.
  • McSherry CK, Ferstenberg H, Virshup M. The Mirizzi syndrome: suggested classfication and surgical therapy. Surg Gastroent. 1982;1:219–25.
  • Csendes A, Diaz JC, Burdiles P, Maluenda F, Nava O. Mirizzi's syndrome and cholecystobiliary fistula: a unifying classification. Br J Surg. 1989;76(11):1139-43.
  • Pemberton M., Wells A.D. The Mirizzi syndrome. Postgrad Med J 1997;73(862):487-90.
  • Waisberg J, Corona A, de Abreu IW, et al. Benign obstruction of the common hepatic duct (Mirizzi syndrome):diagnosis and operative management. Arq Gastroenterol 2005;42(1): 13–8.
  • Lai EC, Lau WY. Mirizzi syndrome: history, present, and future development. Anz J Surg 2006;76(4):251-7.
  • Toursarkissian B, Holley DT, Kearney PA, et al. Mirizzi’s syndrome. South Med J 1994; 87(4):471–5.
  • Prasad TL, Kumar A, Sikora SS, Saxena R, Kapoor VK. Mirizzi syndrome and gallbladder cancer. J Hepatobiliary Pancreat Surg. 2006;13(4):323–6.
  • Steinberg WM. The clinical utility of the CA 19–9 antigen. Am tumor-associated 1990;85(4):350–5. J Gastroenterol.
  • Shah OJ, Dar MA, Wani MA, Wani NA. Management of Mirizzi syndrome: a new surgical approach. ANZ J Surg 2001;71(7): 423-7.
  • Baer HU, Matthews JB, Schweizer WP, et al. Management of the Mirizzi syndrome and the surgical implications of cholecystocholedochal fistula. Br J Surg 1990;77(7):743-5.