title: The relationship of Mirizzi syndrome and cholecystoenteric fistula: validation of a modified classification.
abstract: BACKGROUND
  Mirizzi syndrome and cholecystoenteric fistula with or without gallstone ileus are late complications of gallstone disease. We previously suggested that the natural history of Mirizzi syndrome may not end with just a cholecystobiliary fistula and that the continuous inflammation in the triangle of Calot area may result in a complex fistula involving the biliary tract and the adjacent viscera. The purpose of this study was to establish the relationship of Mirizzi syndrome with cholecystoenteric fistulas.
  
  
  METHODS
  We retrospectively reviewed the records of all patients older than aged 18 years submitted to emergency or elective cholecystectomy from 1995 to 2006. Of 5,673 cholecystectomies performed during that period, we found 327 (5.7%) patients with Mirizzi syndrome and 105 (1.8%) patients with cholecystoenteric fistula. Ninety-four (89.5%) patients with cholecystoenteric fistula also had an associated Mirizzi syndrome.
  
  
  RESULTS
  Cholecystoenteric fistula was associated with Mirizzi syndrome (p < 0.0001), increased age was associated with Mirizzi syndrome and cholecystoenteric fistula (p < 0.0001), and female gender was associated with Mirizzi syndrome (p < 0.0001).
  
  
  CONCLUSIONS
  When during surgery for gallstone disease a cholecystoenteric fistula is encountered, the possibility of an associated Mirizzi syndrome must be considered. The findings of this study confirm the association of Mirizzi syndrome with cholecystoenteric fistula.
authors.affiliation: Department of Surgery, Hospital De Ovalle, Ovalle, Chile. beltran_01@yahoo.com
authors.forename: Marcelo A
authors.initials: MA
authors.lastname: Beltran
authors.forename: Attila
authors.initials: A
authors.lastname: Csendes
authors.forename: Karina S
authors.initials: KS
authors.lastname: Cruces
mesh_terms: D001658:Biliary Fistula / Q000145:classification* / Q000209:etiology / Q000601:surgery; D002763:Cholecystectomy / Q000009:adverse effects* / Q000379:methods; D003137:Common Bile Duct Diseases / Q000145:classification* / Q000209:etiology / Q000601:surgery; D005260:Female; D042882:Gallstones / Q000150:complications*; D006801:Humans; D007412:Intestinal Fistula / Q000145:classification* / Q000209:etiology; D007579:Jejunal Diseases / Q000145:classification* / Q000209:etiology / Q000601:surgery; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013272:Stomach Diseases / Q000150:complications / Q000601:surgery; D013577:Syndrome