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Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Mirizzi syndrome occurs when there is extrinsic compression and obstruction of the common bile duct secondary to a gallstone in the cystic duct. Ultrasound shows dilatation of the common bile duct to the level of a stone that lies outside of the common bile duct in the cystic duct. The gallbladder wall is often thickened.
Hepatobiliary Surgery
Published in Gozie Offiah, Arnold Hill, RCSI Handbook of Clinical Surgery for Finals, 2019
➢ Post-hepatic (obstructive)Intraluminal.■ CholedocholithiasisMural abnormalities.■ Biliary stricture■ Primary sclerosing cholangitisExtrinsic compression of the bile ducts.■ Carcinoma of the head of pancreas, ampulla of Vater or bile duct.■ Chronic pancreatitis■ Enlarged lymph nodes in porta hepatis.■ Mirizzi’s syndrome: external biliary compression from a stone impacted in the neck of the gallbladder.
Test Paper 6
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
The sonographic findings of an impacted gallstone within the neck of bladder causing proximal biliary dilatation are diagnostic for Mirizzi syndrome. Mirizzi syndrome is caused by impaction of a large gallstone in the cystic duct, cystic duct remnant or gallbladder neck. The impacted stone causes external compression of the CBD, resulting in proximal dilation of the biliary tree. A choledochocoele is cystic dilatation of the CBD within the lumen of the duodenum. Caroli disease is a congenital disorder characterised by saccular dilatations of intrahepatic ducts. Caroli disease, in association with congenital hepatic fibrosis, polycystic kidney disease and others, is known as Caroli syndrome.
Clinical outcome of gallstone ileus; a single-centre experience of case series and review of the literature
Published in Acta Chirurgica Belgica, 2022
Feyyaz Gungor, Yigit Atalay, Nihan Acar, Emine Ozlem Gur, Ibrahim Kokulu, Turan Acar, Sebnem Karasu, Osman Nuri Dilek
In terms of aetiology, GI usually occurs due to a bilioenteric fistula; and 60% of which are cholecystoduodenal, but cholecystocolonic and cholecystogastric fistulas can also can result in GI [8]. In our series, among the patients who underwent surgery, bilioduodenal and biliocolonic fistulas were detected in seven (63.6%) and one (9%) patients, respectively. Bilioduodenal fistula was detected on CT of two patients (18.1%) who were treated conservatively. Bilioenteric fistula was not detected in one (9%) patient who underwent surgery. A relation between Mirrizzi syndrome and cholecystoenteric fistula has been proposed; wherein, the hypothesis that the stone within the cystic duct causes compression of the common hepatic duct and creates cholecystoenteric fistula for the drainage of bile and gallstones, was supported [9]. In a series of 5673 cholecystectomy cases, it was reported that 327 (5.7%) patients had Mirizzi syndrome and 105 (1.8%) patients had cholecystoenteric fistula [10]. Mirizzi syndrome was not encountered in our series.
Developments in the Diagnosis and Management of Cholecystoenteric Fistula
Published in Journal of Investigative Surgery, 2022
Ying-Yu Liu, Shi-Yuan Bi, Quan-Run He, Ying Fan, Shuo-Dong Wu
Mirizzi syndrome was first described and reported in 1948. It refers to the continuous entrapment and compression of the gallbladder ampulla and neck, resulting in stenosis or fistula of the common hepatic duct. This is accompanied by recurrent cholecystitis, cholangitis, and obstructive jaundice [19]. Previous studies have shown that Mirizzi syndrome is related to CEF, and the possibility of Mirizzi syndrome should be kept in mind when CEF is discovered [20]. Csendes’ classification is used to classify Mirizzi syndrome into five types. Type I: external common hepatic duct compression (Ia: gallstone occluded in the cystic duct or gallbladder neck, Ib: no occlusion). Type II: cholecystocholedochal fistula with 1/3 erosion of the common hepatic duct wall. Type III: cholecystocholedochal fistula with 2/3 erosion of the common hepatic duct wall. Type IV: cholecystocholedochal fistula combined with total erosion of the common hepatic duct wall. Type V: any of type I-IV with CEF (Va: without gallstone ileus, Vb: with related gallstone ileus). Duodenal and gastric fistulas form the majority of reported cases, while colonic fistulas are rare [21]. Bile can pass through the fistula into the digestive tract, but symptoms may occur when stones compress the fistula and cause obstruction. Imaging findings associated with Mirizzi syndrome may not be distinguishable from biliary or periampullary malignancy. The presence of enlarged lymph nodes or masses in the portal vein and liver may help distinguish between the Mirizzi syndrome and biliary/periampullary malignancy. Medical history and physical examinations are also important for diagnosis. In the case of unclear anatomical structure, if there is serious inflammation and adhesion of the gallbladder triangle, it is best to choose open surgery [22]. Laparoscopic surgery can be used in cases with clear anatomy.
High level of tumor marker CA19-9 returned to normal after cholecystectomy in calculous cholecystitis patients
Published in Scandinavian Journal of Gastroenterology, 2023
Wanjin Chen, Shouwen Wang, Hongchuan Zhao, Guobin Wang, Rong Qin, Fan Huang, Wei Geng, Zimei Liu, Wei Wang, Ruolin Wu, Liujin Hou, Zhenghui Ye, Xinghua Zhang, Xiaoping Geng, Xiaojun Yu
CA19-9 is an antigen of the Lewis A blood group determinant [1], mainly distributed in stomach, pancreas, and biliary epithelium [10–13]. Since it was discovered, serum CA19-9 is most commonly used as a tumor marker to help diagnosis of hepatobiliary and pancreatic malignancies [14,15]. A large number of studies have shown that the sensitivity and specificity of serum CA19-9 are 69-93% and 46–98% in pancreatic cancer and 28.7–88% and 67–94.5% in biliary tract cancer, respectively [16–20]. In addition, another study based on 819 patients found that the higher CA19-9 level, the greater the probability of malignant disease, which was 87.2% when serum CA19-9 was between 37 U/ml and 1000 U/ml, and as high as 93.5% when serum CA19-9 was greater than 1000 U/ml [21]. Nevertheless, high serum CA19-9 level caused by benign diseases is still worthy of attention, including pancreatitis and biliary obstruction [21]. Furthermore, there have also been some case reports about high serum CA19-9 in cholecystitis. Moshref et al. reported a cholecystitis patient with high serum CA19-9, but ignored the patient was accompanied by Mirizzi’s syndrome that leads to biliary obstruction [22]. Haring et al. reported a xanthogranulomatous cholecystitis patient with high serum CA19-9, but ignored the patient also had obstructive choledocholithiasis [23]. Akimoto et al. reported a calculous cholecystitis patient with high serum CA19-9, but ignored the patient also had a liver mass detected by PET-CT, which could be the reason of high serum CA19-9 [24]. Mehmet et al. reported a calculous cholecystitis patient whose serum CA19-9 returned to normal after CCY, but no further IHC analysis was performed on gallbladder specimens [25]. None of these case reports can define the causality between calculous cholecystitis and serum CA19-9. Therefore, in this research, the causality between calculous cholecystitis and serum CA19-9 was studied excluding pancreatitis and biliary obstruction which were reported to be associated with high serum CA19-9, and gallbladder specimens were also analyzed by IHC.