OPTION TO FINISH SURGICAL OPERATION IN PATIENT WITH MIRIZZI SYNDROME

Abstract

Mirizzi syndrome is a rare condition caused by the obstruction of the common bile duct or common hepatic duct by external compression from multiple impacted gallstones or a single large impacted gallstone in Hartman's pouch. Mirizzi syndrome is one of the most severe complications of cholelithiasis and the most complex pathological process in biliary surgery in general. Mirizzi syndrome is a compression of the common hepatic bile duct by a gallstone, which is usually located in Hartmann's pouch, and the subsequent formation of a cholecysto-choledochial fistula. This syndrome is named after the Argentinean surgeon, who described the obstruction of the common bile duct or common hepatic duct by external compression from multiple impacted gallstones or a single large impacted gallstone; the phenomenon was observed during the intraoperative cholangiography. Mirizzi syndrome is conventionally classified into four types: type I is described as the compression of the common hepatic duct by a stone from the gallbladder side; type II is characterized by the presence of a cholecysto-choledochial fistula that involves one-third of the choledochus diameter; type III is similar to type II but involves two-thirds of the choledochus diameter; type IV represents complete destruction of the wall of the common hepatic duct, resulting in the formation of a complete biliobiliary fistula. Mirizzi syndrome does not have its own specific clinical manifestations, and screening methods like abdominal ultrasonography may not always provide a clear indication of this pathology. In such cases, diagnostic procedures such as endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance imaging (MRI) of the biliary tract can help establish an accurate diagnosis and determine the appropriate surgical approach prior to the operation. The article presents the clinical case of a 29-year-old patient M., who was admitted to the surgical department. Although there was a discrepancy between the findings of magnetic resonance imaging of the biliary tract and the identified anatomical changes during diagnostic laparoscopy of the hepatobiliary tract, the surgeons' expertise and adherence to safe cholecystectomy guidelines enabled the successful completion of the operation using a minimally invasive approach.