Introducere: Sindromul Mirizzi (SM) este o complicatie rara a litiazei veziculare cronice cu o incidenta de 0,7-1,4% la pacientii colecistectomizati. Initial SM a fost descris ca o obstructie totala sau partiala a caii biliare principale cu un calcul inclavat in infundibulul vezicular sau ductul cistic printr-o compresie extrinseca, complicata cu icterul obstructiv. Conform clasificatiei Csendes se disting urmatoarele tipuri de SM: tip I, cand calea biliara principala este comprimata de un calcul inclavat in infundibulul vezicular sau ductul cistic fara formarea fistulei colecistobiliare; tip II-IV cu prezenta fistulei colecistobiliare cu diferit grad de eroziune a canalului hepatic comun. Materiale si metode: Pe perioada anilor 2006-2011 raportam 5 cazuri de SM: 1 pacient cu SM tip I, 2 pacienti – tip II si 2 pacienti – tip IV. Doar la doi pacienti diagnosticul de SM a fost suspectat preoperator prin colecistopancreatografie retrograda endoscopica, iar in 3 cazuri diagnosticul a fost instalat intraoperator. La toti pacientii icterul mecanic era insotit de colangita purulenta. Rezultate: Operatia a avut ca scop colecistectomie cu lichidarea fistulei bilio-biliare si rezolvarea icterului obstructiv. Operatia s-a finisat cu aplicarea anastomozei hepaticojejunale pe ansa Roux cu stent biliar (1 bolnav), drenarea coledocului tip Kehr (3), drenarea coledocului tip Halsted (1). Toti pacientii in perioada postoperatorie precoce au fost examinati prin fistulocolangiografie pentru controlul permiabilitatii cailor biliare. Concluzii: SM este o complicatie rara a litiazei veziculare, responsabil de icter si colangita, diferentierea preoperatorie cu cancerul biliar fiind dificila. Rezolvarea chirurgicala a SM depinde de forma morfopatologica conform clasificarii Csendes.

Introduction: Mirizzi syndrome (MS) is a rare complication of longstanding gallbladder stone disease, with an incidence of 0.7-1.4% from all cholecystectomies. SM was originally described as a gallstones impacted in the neck of the gallbladder or cystic duct, which can obstruct the common bile duct (CBD) by extrinsic compression causing obstructive jaundice. According to Csendes classification the following types of MS are distinguished: type I, when the CBD is compressed by a gallstone impacted in cystic duct, without biliary fistula, type II-IV with the bilio-biliary fistula with different degree of destruction of the common hepatic duct wall. Materials and methods: We report 5 patients with MS, treated during the period of 2006-2011: 1 patient with type I MS, 2 patients with type II, and 2 patients with type IV. Only in two patients the MS was suspected prior surgery using endoscopic retrograde cholecystopancreatography, in another three cases the diagnosis was established intraoperatively. Mechanical jaundice in all patients was accompanied by purulent colangitis. Results: The aim of surgery included cholecystectomy, abolition of cholecysto-choledochal fistula, and elimination of obstructive jaundice. Procedure was completed by Roux-en-Y hepaticojejunostomy with biliary stent placement (1patient), suture closure over a T-tube (3), and Halsted tube (1). In the early postoperative period all patients underwent cholangiography in order to control the permeability of the biliary ducts. Conclusions: MS is a rare complication of the gallbladder calculous disease which is responsible for obstructive jaundice and cholangitis, the preoperative differentiation with biliary cancer is difficult. The surgical procedure for MS depends on its morphological form according to Csendes classification.