[Mirizzi syndrome associated with complicated cholelitiasis in the elderly patient. Diagnosis and laparoscopic treatment].
BACKGROUND
The Mirizzi Syndrome (MS) is a rare variation of cholelitiasis, in which a calculus impacted in the Hartmann Pouch compresses the biliary pathway triggering an obstructive jaundice, frequently followed by inflammatory phenomenon and a number of complications.


OBJECTIVE
To establish the frequency of the Mirizzi Syndrome in complicated cholelitiasis in the elderly patient and analyze the most suitable diagnosis and treatment options.


METHODS
Cases of Mirizzi Syndromes in symptomatic inflammatory biliary lithiasis were selected in a five-year period among patients older than 70, who had undergone urgent operation. Epidemiology, private hospital, diagnosis, operating variables, morbility and hospitalization were analyzed.


RESULTS
Twelve (12) patients with Mirizzi Syndrome were detected, with an average age of 77.2 in 197 cases of complicated cholelitiasis. A laparoscopic examination was made in 67% of the cases, with a conversion rate of 50%. The most frequent finding was the biliary extrinsic compression without Csendes-I fistula (58%). The postsurgical morbility was of 58%, including two deaths (17%) and the medium-term postoperative hospital stay was of 9.5 days.


CONCLUSIONS
This research emphasizes the importance of the Mirizzi Syndrome (MS) in the symptomatic cholelitiasis in geriatric patients. This syndrome usually acts like a biliar surgical emergency and the early diagnosis of an elderly patient with jaundice is the key that enables immediate biliary decompression through a cholecystectomy. Management choices are in debate; however, due to its advantages in cases of elderly patients, a laparoscopic treatment is proposed, unless strictly contraindicated.
Sánchez Beorlegui
Jesús
J
Servicio de Cirugía General y Digestiva, Fundación Hospital de Calahorra, La Rioja, Spain. js_beorlegui@hotmail.com
Monsalve Laguna
Eduardo
E
Soriano Gil-Albarellos
Pablo
P
Cabezali Sánchez
Roger
R
Moreno de Marcos
Nuria
N
Aspíroz Sancho
Antonio
A
D000368:Aged; D000369:Aged, 80 and over; D002769:Cholelithiasis / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D006801:Humans; D041781:Jaundice, Obstructive / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D012189:Retrospective Studies; D013577:Syndrome