Abstract

SANCHEZ BEORLEGUI, Jesús et al. Mirizzi Syndrome associated with complicated Cholelitiasis in the elderly patient: diagnosis and laparoscopic treatment. Rev. gastroenterol. Perú [online]. 2008, vol.28, n.1, pp.15-21. ISSN 1022-5129.

INTRODUCTION: The Mirizzi Syndrome (MS) is a rare variation of cholelitiasis, in which a calculus impacted in the Hartmann Pouch compresses the biliary pathway triggering an obstructive jaundice, frequently followed by inflammatory phenomenon and a number of complications.   OBJECTIVE: To establish the frequency of the Mirizzi Syndrome in complicated cholelitiasis in the elderly patient and analyze the most suitable diagnosis and treatment options.   PATIENTS AND METHOD: Cases of Mirizzi Syndromes in symptomatic inflammatory biliary lithiasis were selected in a five-year period among patients older than 70, who had undergone urgent operation. Epidemiology, private hospital, diagnosis, operating variables, morbility and hospitalization were analyzed.   RESULTS: Twelve (12) patients with Mirizzi Syndrome were detected, with an average age of 77.2 in 197 cases of complicated cholelitiasis. A laparoscopic examination was made in 67% of the cases, with a conversion rate of 50%. The most frequent finding was the biliary extrinsic compression without Csendes-I fistula (58%). The postsurgical morbility was of 58%, including two deaths (17%) and the medium-term postoperative hospital stay was of 9.5 days.   CONCLUSIONS: This research emphasizes the importance of the Mirizzi Syndome (MS) in the symptomatic cholelitiasis in geriatric patients. This syndrome usually acts like a biliar surgical emergency and the early diagnosis of an elderly patient with jaundice is the key that enables immediate biliary decompression through a cholecystectomy. Management choices are in debate; however, due to its advantages in cases of elderly patients, a laparoscopic treatment is proposed, unless strictly contraindicated.

Keywords : Cholelitiasis; obstructive jaundice; biliary obstruction; Mirizzi Syndrome; biliary fistula; laparoscopic surgery.

        · abstract in Spanish     · text in Spanish     · Spanish ( pdf )