Introduction:

Mirizzi Syndrome (MS) is uncommon, showing an incidence of less than 1% per year in developed countries in the West and from 4.7% to 5.7% in developing countries. The incidence reported in Mexico is 4.7%. There is no established difference between male and female sex. It prevails between the fourth and seventh decade of life. The incidence increases in patients undergoing cholecystectomy at 0.3-5% and 0.1-2.7% in patients with cholelithiasis, while patients with vesicular cancer are those with the highest risk (> 25%).1 The clinical diagnosis of MS is difficult when taking into account that there are no pathognomonic patterns of presentation. The symptomatology, generally, is the same as that of acute cholecystitis and/or choledocholithiasis: pain in the epigastrium, or in the right hypochondrium, which can radiate to the back, jaundice; and some cases show altered liver function tests.2 Despite the development of modern imaging techniques available in most of the scenarios, the diagnosis is transoperative. In this way, an adequate preoperative surgical planning is avoided; and only an experienced intraoperative recognition could avoid the high incidence of bile duct injury, frequent in this entity.3 Endoscopic retrograde cholangiopancreatography (ERCP) is the most appropriate study to show the cause of jaundice and allow in some cases the extraction of a stone, riding a cystic-choledocian communication.4 The adequate preoperative recognition of this entity is a crucial piece of information that can influence the surgical approach and reduce the risk of operative complications.5 For patients not candidates for surgery, such as elderly patients with comorbidities, endoscopy can provide an adequate definitive treatment.6

Objective:

To know the statistics of patients with MS as a finding in ERCP procedures due to obstructive jaundice, to compare the percentage obtained with the literature reported and to assess the diagnostic usefulness of the condition.

Material and methods:

Quantitative design study. Observational, transversal, descriptive, retrospective. The statistics of the endoscopy unit of UMQ Juárez Centro were collected. Based on this, we analyzed the records of patients undergoing ERCP from March 1, 2018 to February 28, 2019 and those with MS finding by fluoroscopy.

Inclusion criteria:

Patients undergoing ERCP at UMQ Juárez Centro from March 1, 2018 to February 28, 2019. Patients with Mirizzi syndrome due to fluoroscopy.

Exclusion criteria:

Patients undergoing ERCP with previous cholecystectomy.

Results:

In the studies reviewed from March 1, 2018 to February 29, 2019 were found 232 patients undergoing ERCP, 181 female and 51 male (Figure 1), of which 32 patients (13.79%) were found with finding of SM (Figure 2); 24 female (13.25%) 8 male (15.68%). With an average age of 37.2 years. 29 MS type I, 2 type II, 1 type IV (Figure 3) were reported. The therapy used was as follows; sphincterotomy: 26 patients, balloon sweep due to concomitant choledocholithiasis: 6 patients, stent placement: 2 patients (Figure 4).

Discussion:

We found 232 patients undergoing ERCP, without prior cholecystectomy, finding a 3.5: 1 M: H ratio (181M, 51H) and an incidence of MS of 12.12% in our hospital unit. The prevalence of age is found in the fourth decade of life, which correlates with the world literature reported. It was possible to administer therapy in patients with this complication, including sphincterotomy, balloon sweeping and placement of prostheses in cases of difficult management. Our hospital being a reference unit of other hospitals in the network, we have the limitation of the postoperatrory follow-up of the patient, and it is difficult to know the success cases regarding the surgical planning of the same, so it is a point of future improvement to know the benefits of these findings.

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