Document Type

Article

Publication Date

7-1-1997

Comments

This article has been peer reviewed. It was published in: Journal of the Society of Laparoendoscopic Surgeons

Volume 1, Issue 3, July-Sept 1997, Pages 237-9.

The published version is available at PMID: 9876678. Copyright © The Laparoscopic Surgery Information Source

Abstract

Mirizzi syndrome type II is an uncommon cause of obstructive jaundice caused by an inflammatory response to an impacted gallstone in Hartmann's pouch or the cystic duct with a resultant cholecystocholedochal fistula. Two cases of Mirizzi syndrome type II are presented. Clinically only one patient had jaundice and endoscopic retrograde cholangiopancreatogram (ERCP) established a preoperative diagnosis of Mirizzi syndrome. The other patient's diagnosis of Mirizzi syndrome was made intraoperatively. It is important to properly identify the anatomy at the time of surgery to avoid compromising the common bile duct. Operative treatment of Mirizzi syndrome type II includes laparoscopic or open subtotal cholecystectomy; placement of a T-tube with either laparoscopic or open cholecystectomy; or creation of a hepaticojejunostomy with cholecystectomy. Although there is a report of laparoscopic treatment of this syndrome without long term follow-up, we believe that once there is any question of injury to the common bile duct, safety demands that the laparoscopic procedure be converted to an open one with implementation of appropriate therapy.

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