Mirizzi's syndrome must be ruled out in the differential diagnosis of any patients with obstructive jaundice

BACKGROUND/AIMS: Mirizzi syndrome is a rare benign complication of long-sta nding cholelithiasis and neither diagnostic modality nor clinical feature h as a 100% sensitivity and specificity. The objective of our study was to ca ll attention to the importance of this rare syndrome with its miscellaneous treatments. METHODOLOGY: Between January 1992 and June 1997, a total of 8 (4 females an d 4 males) patients, who were operated and diagnosed as Mirizzi syndrome, w ere retrospectively evaluated. RESULTS: The mean age was 53.75 years. During the same time period 0.98% of the total 812 cholelithiasis patients were Mirizzi syndrome. The ultrasoun d was used in 7, computed tomography (CT)in 4 and endoscopic retrograde cho langiopancreatography (ERCP) in 2 cases. Ultrasound allowed the detection o f cholelithiasis in all, but proximal bile duct dilatation in only 71% of c ases. CT detected the non-specific findings of syndrome in 75% of cases. In 2 patients, because of the difficulties due to the patients themselves and the technical management problems, ERCP could not detect the pathology pro perly. In 2 of 5 type I patients, we performed only cholecystectomy and in another 2 cholecystectomy plus T-tube drainage. In 1 case, due to major hep atic duct injury during surgery, cholecystectomy plus hepaticojejunostomy o ver the Y-stent was performed. Biliary fistula developed in I patient with T-tube drainage and was successfully managed with conservative treatment. I n all type II patients we preferred cholecystectomy plus choledochoduodenos tomy and all of them were free of complications. CONCLUSIONS: If there is no question about the security of the common bile duct at surgery in type I patients, we recommended cholecystectomy, otherwi se cholecystectomy plus exploration of common bile duct and/or drainage sho uld be the procedure of choice. However, in type II patients cholecystectom y plus choledochoduodenostomy is a safe and effective procedure to perform.