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Query: UMLS:C0023890 (cirrhosis)
 42,195 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the paper are 2 cases of the so called Mirizzi's syndrome presented, as a special clinical entity in the surgery of the biliary tract. Pablo Mirizzi (Cordoba, Argentina, 1948) performed the basic scientific observations, so the syndrome was named after him. There are 4 basic components: 1. Anatomic variations of the gall entrance, namely ductus cystic with the main gall canal, while ductus cystic has a prolonged parallel course with choleductus, 2. Impacted concrement in the gall throat or even ductus cystic, 3. A part of entire choleductus compression with extra luminar pathologic substrate, and 4. The consequences of the gall recurrent cholangitis, namely cholangitis cirrhosis. A long lasting compression of the choleductus wall due to the jammed concrement, sooner or later, may bring to the wall necrosis and penetration of the concrement into the choleductus lumen (make a bilio-biliary fistula) with all the perils. The mentioned circumstances, in the course of the operation being a number of serious post-operative complications (being obvious from the presented cases). Now days, a great importance is given to the Mirizzi's syndrom in the prevention of the post-operative complications relating to the outstanding clinical entity.
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PMID:[The Mirizzi syndrome in biliary surgery]. 134 50

Laparoscopic subtotal cholecystectomy has been carried out on 5 patients during a 28-month period. The indications were severe inflammation/fibrosis in 3 patients, cirrhosis with mild portal hypertension in 1 patient and the Mirizzi syndrome in the last patient. There were no deaths and only minor in hospital morbidity. Subtotal cholecystectomy carried out laparoscopically is a safe procedure and can be used in selected patients in order to avoid conversion to an open operation.
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PMID:Laparoscopic subtotal cholecystectomy. 773 90

Fourteen cases of Mirizzi's syndrome are presented here. Clinical presentation was pain (14), jaundice (14), fever (10) and peritonitis (1). A clinical diagnosis of choledocholithiasis was considered in all the patients. Pre-operative diagnosis of Mirizzi's syndrome was made in five patients on the basis of cholangiogram and the remaining cases were diagnosed at surgery. The stage (type) of Mirizzi's syndrome was based on the extent of erosion of the common bile duct. Four patients had type I, seven type II and three type III lesions. Associated choledocholithiasis was present in five and acute free perforation of the gall-bladder in one. The operative procedures performed were partial cholecystectomy for type I, partial cholecystectomy, choledochoplasty and T-tube choledochostomy for type II and bilioenteric anastomosis for type III lesions. Two patients had retained common bile duct stones. Mean follow up was 14 months (range 1-27 months). One patient with secondary biliary cirrhosis continues to have persistently elevated serum alkaline phosphatase levels without any demonstrable biliary obstruction. Diagnostic and operative strategies are discussed and a follow up protocol for such patients is suggested.
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PMID:Mirizzi's syndrome: identification and management strategy. 827 24

We present five patients with Mirizzi syndrome diagnosed by ERCP. This syndrome is a rare cause of obstructive jaundice due to common biliary duct compression by a gallstone impacted in the cystic duct, neck of the gallbladder or Hartmann's pouch. Complications are bilio-biliary fistula, cholangitis and secondary biliary cirrhosis. Diagnostic methods, importance of preoperative diagnosis and surgical technics are reviewed.
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PMID:[Mirizzi's syndrome: a rare cause of obstructive jaundice]. 836 48

P.L. Mirizzi described in 1948 a partial or spastic obstruction of the common hepatic duct secondary to an impacted gallstone in the cystic duct or infundibulum of the gallbladder. The modern definition of Mirizzi's syndrome is thought to include four components: anatomic arrangement of the cystic duct at the gallbladder neck such that it runs parallel to the common hepatic duct; impaction of a stone in the cystic duct or neck of the gallbladder; mechanical obstruction of the common hepatic duct by the stone itself or by secondary inflammation; and intermittent or constant jaundice causing possible recurrent cholangitis and, if longstanding, secondary biliary cirrhosis. Intermittent symptomatology may make Mirizzi's syndrome difficult to diagnose preoperatively or intraoperatively. Bilio-biliary fistulas may or may not be present. Diagnosis and choice of operative repair may be best accomplished by open operative technique. Over a 24-year period two faculty members from Louisiana State University (LSU) Medical Center-Shreveport at Monroe and LSU Baton Rouge treated 4180 cases of cholelithiasis at six Louisiana university and private hospitals. Eleven cases of Mirizzi's syndrome were diagnosed on the basis of operative and preoperative notes with detailed description of size and extent of biliobiliary fistulas when they were present. These 11 cases were reviewed and followed from one to 20 years. Presentation, workup, operative findings, choice of operative repair, choice of operative approach, and complications were evaluated by retrospective chart review. Review of the pertinent literature for informative and comparative purposes was also completed. These 11 cases ranged from Csendes Type I to III. There were no Type IV cases. They were ultimately diagnosed and managed by classical open technique. Four laparoscopic procedures were converted to open technique following initial inspection. All four were converted to open as a result of inability to delineate structures in and adjacent to the triangle of Calot due to marked scarring in the subhepatic space. No iatrogenic injuries or major complications occurred. Mirizzi's syndrome occurs in fewer than 0.5 per cent of patients with cholelithiasis. Removal of stones with partial cholecystectomy and use of gallbladder or cystic duct remnant to oversew or repair Mirizzi fistulas should be considered. Roux-en-y hepaticojejunostomy becomes the procedure of choice when the vascularity or viability of the hepatic duct or tissues available for duct repair is questionable. Review of the literature reveals the increase in complications with laparoscopic versus open technique in Mirizzi's syndrome. Although very little direct evidence exists we believe that when this syndrome is diagnosed or strongly suspected open biliary operation is the procedure of choice because the increased potential for major complications with the use of laparoscopic technique far outweighs the potential slight increase in morbidity of an open procedure.
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PMID:Mirizzi's syndrome: experience from a multi-institutional review. 1120 88

An analysis of surgical treatment of 124 patients with "difficult" gallbladder has shown that in most cases (59.7%) the causes impeding surgical procedures were massive commissural processes in the gallbladder zone and stony infiltrates of the hepato-duodenal ligament with shrunken or sclerosed gallbladder as well as earlier operations on the gallbladder, a combination of echinococcosis and liver cirrhosis with acute calculous cholecystitis, cholecystodigestive fistulas, Mirizzi syndrome and intrahepatic location of the gallbladder. Videolaparoscopic operations in such cases are extremely difficult, so open laparotomic operations should be preferred.
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PMID:[Surgical treatment of patients with complicated forms of cholelithiasis]. 1766 81

Choledochal cysts are congenital anomalies of the biliary tract manifested by cystic dilatation of the extrahepatic and intrahepatic bile ducts. Choledochal cyst is not rare in far-East Asian countries. Type II choledochal cysts account for 2% of all such cysts. They are true diverticula of the extrahepatic bile duct and communicate with the bile duct through a narrow stalk. This condition is associated with significant complications, such as ductal strictures, stone formation, cholangitis, rupture and secondary biliary cirrhosis. We describe a case of a huge impacted stone in a diverticular choledochal cyst which masqueraded as an unusual cystic duct stone causing Mirizzi's syndrome.
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PMID:Diverticular Choledochal Cyst with a Large Impacted Stone Masquerading as Mirizzi's Syndrome. 2362 17