title: Mirizzi Syndrome: How it could be a challenge.
abstract: OBJECTIVE
  Mirizzi syndrome (MS) is a rare complication of cholelithiasis. This entity should be considered in the differential diagnosis of all patients with obstructive jaundice. Failure to recognize this condition preoperatively can result in a major bile duct injury. In this study, our aim is to describe the clinical presentations, investigations, operative details, endoscopic management and the complications of both procedures.
  
  
  METHODS
  We performed a retrospective analysis on the records of 65 patients with MS. All patients had a cholangiogram; either magnetic resonance cholangiopancreatography (MRCP) or endoscopic retrograde cholangiopancreatography (ERCP). We used a McSherry classification to divide patients with MS into type I MS and type II MS. Those patients had undergone different types of management either ERCP and/or surgery.
  
  
  RESULTS
  The incidence of MS was 0.98% from a total of 4600 patients who had undergone cholecystectomy. From 65 patients with MS, 20 patients underwent ERCP where it was the sole treatment (18 of which had stent while 2 had the stone extracted). The overall surgically treated patients were 45 (23 patients with preliminary ERCP with stent and 22 patients with primary surgical treatment), 18 patients had MS type I while 27 patients had MS type II. Patients with different types of MS underwent different types of surgical procedures.
authors.forename: Ehab
authors.initials: E
authors.lastname: Elhanafy
authors.forename: Ehab
authors.initials: E
authors.lastname: Atef
authors.forename: Ayman
authors.initials: A
authors.lastname: El Nakeeb
authors.forename: Emad
authors.initials: E
authors.lastname: Hamdy
authors.forename: Mohamed
authors.initials: M
authors.lastname: Elhemaly
authors.forename: Ahmad M
authors.initials: AM
authors.lastname: Sultan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation; D049448:Cholangiopancreatography, Magnetic Resonance; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D057792:Mirizzi Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult