Mirizzi Syndrome: Clinical Insights, Diagnostic Challenges, and Surgical Outcomes - A 5-Year Experience from a Tertiary Care Hospital in Pakistan.

Abstract

Background: Mirizzi syndrome (MS) is a rare condition in which the common bile duct or hepatic duct is blocked by impacted gallstones. It can cause symptoms such as cholecystitis, including abdominal pain, nausea, and vomiting. Although diagnosis is challenging, imaging techniques such as ultrasonography and CT scans are helpful. The gold standard for diagnosis is ERCP (Endoscopic Retrograde Cholangiopancreatography). Surgical management is the primary treatment, with laparotomy preferred over laparoscopic procedures.

Methodology: This prospective study was conducted over a period of five years at a tertiary care hospital in Pakistan. A total of 72 patients, aged 21-70 years (mean age 44.81 years), with symptomatic cholelithiasis were included. All patients underwent ultrasonography and, in selected cases, MRCP (Magnetic Resonance Cholangiopancreatography) and ERCP were performed preoperatively. MS was detected preoperatively in 19.4% of cases and intraoperatively in the remaining cases. Data were analyzed using SPSS version 28.

Results: Of the 72 patients, 75% were female. Most patients (69.4%) presented with the right hypochondrium pain, while 16.7% presented with pain and jaundice. Preoperative liver function tests were abnormal in 44.4% of patients. Imaging techniques used included ultrasound (100% of patients), MRCP (22.2%), and ERCP (8.3%). Laparoscopic cholecystectomy was completed in 63.8% of patients, with a conversion rate to open surgery of 30.55%. Two patients required open cholecystectomy with hepaticojejunostomy due to gallstone ileus. The MS types identified were type I (50%), type II (25%), type III (19.4%), type IV (2.77%), and type V (2.77%).

Conclusion: MS is a rare and challenging condition to diagnose. Although imaging techniques are helpful, ERCP remains the gold standard. Surgical management, particularly laparoscopic cholecystectomy, is effective but requires careful implementation by experienced surgeons to avoid complications. In complex cases, laparotomy remains a necessary option.