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  #1  
Old 04-06-2011
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Embarrassed Mirizzi syndrome

Could anyone explain the difference between Mirizzi syndrome and normal choledocholithiasis?
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  #2  
Old 04-06-2011
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Arrow It's a complication

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.
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  #3  
Old 04-06-2011
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Perfect! That was exactly the clarification I needed. Thanks!

Quote:
Originally Posted by lee-usmle View Post
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.
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Old 04-07-2011
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Originally Posted by lee-usmle View Post
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 ??
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Old 04-07-2011
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Originally Posted by good_boy_1234 View Post
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.
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Old 04-07-2011
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Thanks for the explanation,
Are you General Surgery Resident ?

Sorry if it is a private question
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Old 04-22-2011
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Default hi i want to add on....

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!
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Old 04-22-2011
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Quote:
Originally Posted by Drshaharyarkhan View Post
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..
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Old 04-23-2011
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Quote:
Originally Posted by Seetal View Post
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?
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