MIRIZZIS SYNDROME - IDENTIFICATION AND MANAGEMENT STRATEGY

Fourteen cases of Mirizzi's syndrome are presented here. Clinical pres entation was pain (14), jaundice (14), fever (10) and peritonitis (1). A clinical diagnosis of choledocholithiasis was considered in all the patients. Pre-operative diagnosis of Mirizzi's syndrome was made in f ive patients on the basis of cholangiogram and the remaining cases wer e diagnosed at surgery. The stage (type) of Mirizzi's syndrome was bas ed on the extent of erosion of the common bile duct. Four patients had type I, seven type II and three type III lesions. Associated choledoc holithiasis was present in five and acute free perforation of the gall -bladder in one. The operative procedures performed were partial chole cystectomy for type I, partial cholecystectomy, choledochoplasty and T -tube choledochostomy for type II and bilioenteric anastomosis for typ e III lesions. Two patients had retained common bile duct stones. Mean follow up was 14 months (range 1-27 months). One patient with seconda ry biliary cirrhosis continues to have persistently elevated serum alk aline phosphatase levels without any demonstrable biliary obstruction. Diagnostic and operative strategies are discussed and a follow up pro tocol for such patients is suggested.