Mirizzi syndrome

[healer2b]

Could anyone explain the difference between Mirizzi syndrome and normal choledocholithiasis?

[lee-usmle]

Gall stones are commonly found in the gall bladder or in the cystic duct, that's the case in normal choledocholithiasis.
While in Mirizzi syndrome, is a complication of choledocholithiasis in which an impacted cystic duct stone compress "extrinsically" the common hepatic duct.
If this is not recognized preoperatively, it will result in significant morbidity and mortality as the surgeon would only remove the stone in the cystic duct and not knowing that the common hepatic duct is also obstructed.

[healer2b]

Perfect! That was exactly the clarification I needed. Thanks!

Originally Posted by lee-usmle

Gall stones are commonly found in the gall bladder or in the cystic duct, that's the case in normal choledocholithiasis.
While in Mirizzi syndrome, is a complication of choledocholithiasis in which an impacted cystic duct stone compress "extrinsically" the common hepatic duct.
If this is not recognized preoperatively, it will result in significant morbidity and mortality as the surgeon would only remove the stone in the cystic duct and not knowing that the common hepatic duct is also obstructed.

[good_boy_1234]

Originally Posted by lee-usmle

If this is not recognized preoperatively, it will result in significant morbidity and mortality as the surgeon would only remove the stone in the cystic duct and not knowing that the common hepatic duct is also obstructed.

Thanks Lee for the explanation...I did not understand why common hepatic duct is still obstructed while we removed the cause which is cystic duct stone ??

[lee-usmle]

Originally Posted by good_boy_1234

Thanks Lee for the explanation...I did not understand why common hepatic duct is still obstructed while we removed the cause which is cystic duct stone ??

Obstruction leads to inflammation and build up of bile pressure back to the liver. Even when you remove the extrinsic compression you still have the inflammation.
There's lots of details about Mirizzi syndrome and they even classify it into subtypes, but I think what I mentioned is enough for the USMLE level.

[good_boy_1234]

Thanks for the explanation,
Are you General Surgery Resident ?

Sorry if it is a private question

[Drshaharyarkhan]

mirizzi syndrome was taught very well by our professor during my MBBS. actually in mirizzi syndrome the stone( which is usually a small one than one which usually obstructs the cystic duct) gets impacted into HARTMAN'S POUCH( an indentation/pouch just proximal to cystic duct).when this occurs the stone can compress the CBD from outside( coz hartman's pouch is in close proximity with CBD and when the pouch distends it will exert outside pressure on CBD). this may cause obstructive jaundice in the absence of choledocolithiasis or CBD stricture.
Regards!

[Seetal]

Originally Posted by Drshaharyarkhan

mirizzi syndrome was taught very well by our professor during my MBBS. actually in mirizzi syndrome the stone( which is usually a small one than one which usually obstructs the cystic duct) gets impacted into HARTMAN'S POUCH( an indentation/pouch just proximal to cystic duct).when this occurs the stone can compress the CBD from outside( coz hartman's pouch is in close proximity with CBD and when the pouch distends it will exert outside pressure on CBD). this may cause obstructive jaundice in the absence of choledocolithiasis or CBD stricture.
Regards!

dude!!! this was what i was looking for! i was wondering how it causes an obstruction EXTRINSICALLY!! my eyebrows were furrowed and i was getting frustrated with myself for not understanding what the others did. hahaha... thx .... now i see how..

[vienna4u]

Originally Posted by Seetal

dude!!! this was what i was looking for! i was wondering how it causes an obstruction EXTRINSICALLY!! my eyebrows were furrowed and i was getting frustrated with myself for not understanding what the others did. hahaha... thx .... now i see how..

+1 but I dont get why it should lead to hepatic duct obstruction?