Síndrome Mirizzi

Abstract

The purpose of this clinical case was the study of Mirizzi Syndrome, which is a rare complication of cholelithiasis, whose incidence is 0, 7 - 1, 4% at the global level. It is characterized by the presence of a large stone or multiple small gallstones impacted in the Hartmann bag (gallbladder infundibulum) or the cystic duct. The impacted stone more the inflammatory response, generates external obstruction of the bile duct and finally, erodes towards the bile duct where it provokes cholecystocholedochal / cholecystoenteric fistulas or absence of them characteristic of MS type I. The preoperative diagnosis can be difficult; it is facilitated with imaging studies. If the recognition is intraoperative, there must be an adequate handling to avoid the bile duct injury. Its resolution is surgical and depends on the type of Mirizzi. The study presents the clinical manifestation in José Maria Velasco Ibarra Del Tena Hospital. A 33 year old female patient that is admitted to the emergency room for having abdominal pain of two days of evolution as a real date and 2 hours as an apparent date, of high intensity. VAS Scale 10 / 10, located in the epigastrium with irradiation to right hypochondrium, colic pain, which is accompanied by nausea reaching vomiting on 4 occasions of food content, denies thermal rise, choluria or acholia.Physical examination: conscious patient, oriented, in time space and person, icteric skin +/+++, icteric scleras +/++, soft depressible abdomen painful to palpation superficial and deep in epigastrium and right hypochondrium, Positive Murphy’s sign. The pertinent lab tests are required, evidencing the altered patterns and imagenology with the presence of the giant vesicular gallstone and dilated bile duct. ERCP is requested the same one that evidences extrinsic compression of the main bile duct and later Lapchol is performed with resolution of her clinical presentation and recovery.