BACKGROUND: Mirizzi syndrome is a rare disorder consisting of obstruction of the common hepatic duct resulting from gallstone impaction in the cystic duct or neck of the gallbladder. Formation of a biliobiliary fistula is common, and if unrecognized at the time of surgery, may result in major biliary ductal injury. PATIENTS AND METHODS: The severity of biliary tract disease among Native Americans led to this retrospective review of Mirizzi syndrome to determine complications and intraoperative management. A review of 623 biliary tract operations performed from October 1990 to December 1992 identified 17 patients (2.7%) with the disorder, representing a greater incidence than in non-Native American populations. RESULTS: Five patients had type I Mirizzi syndrome with either a parallel cystic duct (2 patients) or an obliterated duct (3 patients). Twelve patients had type II Mirizzi syndrome with a biliobiliary fistula. Cholangiograms were obtained in 12 cases. Seven fistulas were closed primarily and 4 were closed over catheters. There were no deaths, and 4 major complications occurred, including 1 bile-duct injury. A follow-up period of 1 to 3.5 years (mean 2.5) revealed no long-term problems. CONCLUSIONS: Mirizzi syndrome among the Native American population can be managed successfully by appropriate diagnostic and surgical techniques.
BACKGROUND:Mirizzi syndrome is a rare disorder consisting of obstruction of the common hepatic duct resulting from gallstone impaction in the cystic duct or neck of the gallbladder. Formation of a biliobiliary fistula is common, and if unrecognized at the time of surgery, may result in major biliary ductal injury. PATIENTS AND METHODS: The severity of biliary tract disease among Native Americans led to this retrospective review of Mirizzi syndrome to determine complications and intraoperative management. A review of 623 biliary tract operations performed from October 1990 to December 1992 identified 17 patients (2.7%) with the disorder, representing a greater incidence than in non-Native American populations. RESULTS: Five patients had type I Mirizzi syndrome with either a parallel cystic duct (2 patients) or an obliterated duct (3 patients). Twelve patients had type II Mirizzi syndrome with a biliobiliary fistula. Cholangiograms were obtained in 12 cases. Seven fistulas were closed primarily and 4 were closed over catheters. There were no deaths, and 4 major complications occurred, including 1 bile-duct injury. A follow-up period of 1 to 3.5 years (mean 2.5) revealed no long-term problems. CONCLUSIONS:Mirizzi syndrome among the Native American population can be managed successfully by appropriate diagnostic and surgical techniques.