FPre-Operative Ultrasound Diagnostics of Mirizzi Syndrome

Abstract

Background. Mirizzi syndrome (MS) is one of the most severe complications of the gastrointestinal tract and the most complex pathological process in biliary surgery in general. The issue of ultrasound diagnostics (USD) of MS in patients with gallstone disease (GLC) at the preoperative stage for planning the scope of surgical intervention and warning the patient about possible complications is acute. The goal. Determine the sensitivity of preoperative ultrasound in the diagnosis of MS and finding the most significant echo pattern of MS during ultrasound. Materials and Methods. The results of 9126 cholecystectomies performed in the Kharkiv Clinical Hospital on railway transport No. 2 for the period from 1997 to 2023 were analyzed, while MS was suspected in 159 (1.7%) patients by ultrasound. Out of 159 in whom signs of MS were detected by ultrasound, MS was reliably confirmed intraoperatively in 116 (72,9%) patients, and no SM was detected in 43 (27,1%) patients. MS I type was detected in 98 (84.49%) patients, MS II type – 18 (15.51%). Among them there were 87 (75) women, 29 (25) men, the age of the patients ranged from 37 to 80 years (on average – 66.4 years). To analyze the sensitivity of certain echo characteristics during preoperative ultrasound in case of suspicion of SM, the diagnostic sensitivity index (DS) was used. Results. It was established that the most sensitive echocardiogram is the absence of a clear border between the back wall of the gallbladder and the hepaticocholedochus, the frequency is 75.40%. The next sign of sensitivity, which was confirmed intraoperatively, is a shrunken gall bladder, the DS indicator is 54.55%. It was also established that the combination of such echo features as: a shrunken gallbladder and the absence of a clear border between the back wall of the gallbladder and hepatic choledochal, which was detected in 25, in 23 of them, MS was confirmed intraoperatively, the DS rate was 92%. Conclusions. Ultrasound allows with a high (72,9%) degree of probability to establish the presence of SM at the preoperative stage. A reliable ultrasound sign of the presence of SM is the visualization of the common wall between the gallbladder and the hepaticocholedochus – DS 75.40%. With a combination of echo signs: shrunken gallbladder and deformation of the wall of the hepaticocholedochus in the place of attachment of the gallbladder, it is possible to assume MS with a high percentage of reliability (92%) with the help of ultrasound at the preoperative stage. The received information about the high probability of the presence of MS before the operation allows you to correctly plan possible options for the volume and tactics of surgical intervention.