Mirizzi's syndrome pathophysiology: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
Mirizzi’s syndrome is caused by gallstone impaction in the [[cystic duct]] or neck of [[gallbladder]] resulting in chronic [[inflammation]] that leads to the compression, [[necrosis]] and [[fibrosis]] of [[common bile duct]]. This can result in [[fistula]] formation into the adjacent structures like [[common bile duct]]. The obstruction of bile duct either by direct compression from gallstone or [[scar]] formation results in [[obstructive jaundice]]. | *Mirizzi’s syndrome is caused by gallstone impaction in the [[cystic duct]] or neck of [[gallbladder]] resulting in chronic [[inflammation]] that leads to the compression, [[necrosis]] and [[fibrosis]] of [[common bile duct]]. | ||
*This can result in [[fistula]] formation into the adjacent structures like [[common bile duct]]. | |||
*The obstruction of bile duct either by direct compression from gallstone or [[scar]] formation results in [[obstructive jaundice]]. | |||
It can be divided into four types: | *It can be divided into four types: | ||
'''Type I lesions''' involve external compression of the [[common bile duct]] without any fistula formation. | *'''Type I lesions''' involve external compression of the [[common bile duct]] without any fistula formation. | ||
'''Type II lesions''' involve cholecystobiliary [[fistula]] with erosion of less than one‐third of the circumference of the bile duct. | *'''Type II lesions''' involve cholecystobiliary [[fistula]] with erosion of less than one‐third of the circumference of the bile duct. | ||
'''Type III lesions''' are fistula that involve up to two‐thirds of the duct circumference. | *'''Type III lesions''' are fistula that involve up to two‐thirds of the duct circumference. | ||
'''Type IV lesions''' are complete destruction of the bile duct. <ref name="pmid2597969">{{cite journal |vauthors=Csendes A, Díaz JC, Burdiles P, Maluenda F, Nava O |title=Mirizzi syndrome and cholecystobiliary fistula: a unifying classification |journal=Br J Surg |volume=76 |issue=11 |pages=1139–43 |date=November 1989 |pmid=2597969 |doi=10.1002/bjs.1800761110 |url=}}</ref> | *'''Type IV lesions''' are complete destruction of the bile duct. <ref name="pmid2597969">{{cite journal |vauthors=Csendes A, Díaz JC, Burdiles P, Maluenda F, Nava O |title=Mirizzi syndrome and cholecystobiliary fistula: a unifying classification |journal=Br J Surg |volume=76 |issue=11 |pages=1139–43 |date=November 1989 |pmid=2597969 |doi=10.1002/bjs.1800761110 |url=}}</ref> | ||
In 2008, Beltran et al described additional '''Type V lesions''' referring to presence of any of the above 4 types plus the formation of cholecystoenteric fistula. <ref name="pmid29369192">{{cite journal |vauthors=Chen H, Siwo EA, Khu M, Tian Y |title=Current trends in the management of Mirizzi Syndrome: A review of literature |journal=Medicine (Baltimore) |volume=97 |issue=4 |pages=e9691 |date=January 2018 |pmid=29369192 |pmc=5794376 |doi=10.1097/MD.0000000000009691 |url=}}</ref> <ref name="pmid23002333">{{cite journal |vauthors=Beltrán MA |title=Mirizzi syndrome: history, current knowledge and proposal of a simplified classification |journal=World J. Gastroenterol. |volume=18 |issue=34 |pages=4639–50 |date=September 2012 |pmid=23002333 |pmc=3442202 |doi=10.3748/wjg.v18.i34.4639 |url=}}</ref> | *In 2008, Beltran et al described additional '''Type V lesions''' referring to presence of any of the above 4 types plus the formation of cholecystoenteric fistula. <ref name="pmid29369192">{{cite journal |vauthors=Chen H, Siwo EA, Khu M, Tian Y |title=Current trends in the management of Mirizzi Syndrome: A review of literature |journal=Medicine (Baltimore) |volume=97 |issue=4 |pages=e9691 |date=January 2018 |pmid=29369192 |pmc=5794376 |doi=10.1097/MD.0000000000009691 |url=}}</ref> <ref name="pmid23002333">{{cite journal |vauthors=Beltrán MA |title=Mirizzi syndrome: history, current knowledge and proposal of a simplified classification |journal=World J. Gastroenterol. |volume=18 |issue=34 |pages=4639–50 |date=September 2012 |pmid=23002333 |pmc=3442202 |doi=10.3748/wjg.v18.i34.4639 |url=}}</ref> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 04:41, 23 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pathophysiology
- Mirizzi’s syndrome is caused by gallstone impaction in the cystic duct or neck of gallbladder resulting in chronic inflammation that leads to the compression, necrosis and fibrosis of common bile duct.
- This can result in fistula formation into the adjacent structures like common bile duct.
- The obstruction of bile duct either by direct compression from gallstone or scar formation results in obstructive jaundice.
- It can be divided into four types:
- Type I lesions involve external compression of the common bile duct without any fistula formation.
- Type II lesions involve cholecystobiliary fistula with erosion of less than one‐third of the circumference of the bile duct.
- Type III lesions are fistula that involve up to two‐thirds of the duct circumference.
- Type IV lesions are complete destruction of the bile duct. [1]
- In 2008, Beltran et al described additional Type V lesions referring to presence of any of the above 4 types plus the formation of cholecystoenteric fistula. [2] [3]
References
- ↑ Csendes A, Díaz JC, Burdiles P, Maluenda F, Nava O (November 1989). "Mirizzi syndrome and cholecystobiliary fistula: a unifying classification". Br J Surg. 76 (11): 1139–43. doi:10.1002/bjs.1800761110. PMID 2597969.
- ↑ Chen H, Siwo EA, Khu M, Tian Y (January 2018). "Current trends in the management of Mirizzi Syndrome: A review of literature". Medicine (Baltimore). 97 (4): e9691. doi:10.1097/MD.0000000000009691. PMC 5794376. PMID 29369192.
- ↑ Beltrán MA (September 2012). "Mirizzi syndrome: history, current knowledge and proposal of a simplified classification". World J. Gastroenterol. 18 (34): 4639–50. doi:10.3748/wjg.v18.i34.4639. PMC 3442202. PMID 23002333.