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World Journal of Surgery

, Volume 32, Issue 10, pp 2237–2243 | Cite as

The Relationship of Mirizzi Syndrome and Cholecystoenteric Fistula: Validation of a Modified Classification

  • Marcelo A. Beltran
  • Attila Csendes
  • Karina S. Cruces
Article

Abstract

Background

Mirizzi syndrome and cholecystoenteric fistula with or without gallstone ileus are late complications of gallstone disease. We previously suggested that the natural history of Mirizzi syndrome may not end with just a cholecystobiliary fistula and that the continuous inflammation in the triangle of Calot area may result in a complex fistula involving the biliary tract and the adjacent viscera. The purpose of this study was to establish the relationship of Mirizzi syndrome with cholecystoenteric fistulas.

Methods

We retrospectively reviewed the records of all patients older than aged 18 years submitted to emergency or elective cholecystectomy from 1995 to 2006. Of 5,673 cholecystectomies performed during that period, we found 327 (5.7%) patients with Mirizzi syndrome and 105 (1.8%) patients with cholecystoenteric fistula. Ninety-four (89.5%) patients with cholecystoenteric fistula also had an associated Mirizzi syndrome.

Results

Cholecystoenteric fistula was associated with Mirizzi syndrome (p < 0.0001), increased age was associated with Mirizzi syndrome and cholecystoenteric fistula (p < 0.0001), and female gender was associated with Mirizzi syndrome (p < 0.0001).

Conclusion

When during surgery for gallstone disease a cholecystoenteric fistula is encountered, the possibility of an associated Mirizzi syndrome must be considered. The findings of this study confirm the association of Mirizzi syndrome with cholecystoenteric fistula.

Keywords

Common Bile Duct Acute Cholecystitis Gallstone Disease Mirizzi Syndrome Gallstone Ileus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Abou-Saif A, Al-Kawas FH (2002) Complications of gallstone disease: Mirizzi syndrome, cholecystocholedocal fistula, and gallstone ileus. Am J Gastroenterol 97:249–254PubMedCrossRefGoogle Scholar
  2. 2.
    Beltran MA, Csendes A (2005) Mirizzi syndrome and gallstone ileus: an unusual presentation of gallstone disease. J Gastrointest Surg 9:686–689PubMedCrossRefGoogle Scholar
  3. 3.
    Özdemír A, Atli MY, Coskun T, Özenc A, Hersek E (1997) Biliary enteric fistulas. Int Surg 82:280–283Google Scholar
  4. 4.
    McSherry CK, Ferstenberg H, Virshup M (1982) The Mirizzi syndrome: Suggested classification and surgical therapy. Surg Gastroenterol 1:219–225Google Scholar
  5. 5.
    Csendes A, Diaz JC, Burdiles P, Maluenda F, Nava O (1989) Mirizzi syndrome and cholecystobiliary fistula: a unifying classification. Br J Surg 76:1139–1143PubMedCrossRefGoogle Scholar
  6. 6.
    Csendes A, Muñoz C, Albán M (2007) Síndrome de Mirizzi—Fístula colecistobiliar, una nueva clasificación. Rev Chil Cir 59(Suppl):63–64Google Scholar
  7. 7.
    Johnson LW, Sehon JK, Lee WC, Zibari GB, McDonald JC (2001) Mirizzi’s syndrome: experience from a multi-institutional review. Am Surg 67:11–14PubMedGoogle Scholar
  8. 8.
    Schäfer M, Schneiter R, Krähenbühl L (2003) Incidence and management of Mirizzi syndrome during laparoscopic cholecystectomy. Surg Endosc 17:1186–1190PubMedCrossRefGoogle Scholar
  9. 9.
    Mithani R, Schwesinger WH, Bingener J, Sirinek R, Gross GWW (2008) The Mirizzi syndrome: multidisciplinary management promotes optimal outcomes. J Gastrointest Surg 12:1022–1028PubMedCrossRefGoogle Scholar
  10. 10.
    Cortes MR, Vasquez AG (2003) Frequency of the Mirizzi syndrome in a teaching hospital. Cir Gen 25:334–337Google Scholar
  11. 11.
    Masannat Y, Masannat Y, Shatnawei A (2006) Gallstone ileus: a review. Mount Sinai J Med 73:1132–1134Google Scholar
  12. 12.
    Chatzoulis G, Kaltsas A, Danilidis L, Dimitrou J, Pachiadakis I (2007) Mirizzi syndrome type IV associated with cholecystocolic fistula: a very rare condition: report of a case. BMC Surg 7:6PubMedCrossRefGoogle Scholar
  13. 13.
    Pavlidis TE, Atmatzidis KS, Papaziogas BT, Papaziogas TB (2003) Management of gallstone ileus. J Hepatobiliary Pancreat Surg 10:299–302PubMedCrossRefGoogle Scholar
  14. 14.
    Doko M, Zovak M, Kopljar M, Glavan E, Ljubicic N, Hochstädter H (2003) Comparison of surgical treatment of gallstone ileus: preliminary report. World J Surg 27:400–404PubMedCrossRefGoogle Scholar
  15. 15.
    Heuman R, Sjödahl R, Wetterfors J (1980) Gallstone ileus: an analysis of 20 patients. World J Surg 4:595–600PubMedCrossRefGoogle Scholar
  16. 16.
    Clavien PA, Richon J, Burgan S, Rohner A (1990) Gallstone ileus. Br J Surg 77:737–742PubMedCrossRefGoogle Scholar
  17. 17.
    Karademir S, Astarcioglu H, Sökmen S, Atila K, Tankurt E, Akpinar H, Coker A, Astarcioglu I (2000) Mirizzi’s syndrome: diagnostic and surgical considerations. J Hepatobiliary Pancreat Surg 7:72–77PubMedCrossRefGoogle Scholar
  18. 18.
    Al-Akeely MHA, Alam MK, Bismar HA, Khalid K, Al-Teimi I, Al-Dossary NF (2005) Mirizzi syndrome: ten years experience from a teaching hospital in Riyadh. World J Surg 29:1687–1692PubMedCrossRefGoogle Scholar
  19. 19.
    Desai DC, Smink RD (1997) Mirizzi syndrome type II: is laparoscopic cholecystectomy justified? J Soc Lap Surg 1:237–239Google Scholar
  20. 20.
    Rohatgi A, Singh KK (2006) Mirizzi syndrome: laparoscopic management by subtotal cholecystectomy. Surg Endosc 20:1477–1481PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  • Marcelo A. Beltran
    • 1
    • 2
  • Attila Csendes
    • 3
  • Karina S. Cruces
    • 1
  1. 1.Department of SurgeryHospital De OvalleOvalleChile
  2. 2.La SerenaChile
  3. 3.Department of SurgeryHospital Clínico De La Universidad De ChileSantiago De ChileChile

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