Abstract:
Background.
With an incidence of 0.7-4.4%, Mirizzi
syndrome is considered a rare and severe
complication of gallstones. Pathology is
even less frequently reported in the
literature in conjunction with other
medical-surgical emergencies.
Purpose.
Analysis of the treatment experience of
the elderly patient with associated severe
surgical emergencies.
Material and methods. Treatment opportunity in a 76-year-old patient with
multiple severe concomitants is presented. Clinical
diagnosis: Mirizzi II syndrome, with progressive
mechanical jaundice; giant antral peptic ulcer,
complicated with repeated digestive bleeding, grade III
anemia; ischemic heart disease, angina pectoris, CI III
NIHA, taxisystolic permanent atrial fibrillation; drug
coagulopathy; hypertension gr. III.
Results.
Hospitalized for progressive mechanical jaundice syndrome. MRI
cholangiography over 24 hours - complicated gallstones with
Mirizzi II syndrome. FGDS - bile absent in the duodenum, at the
same time - in the gastric antral region presence of giant peptic
ulcer. On the 3rd day of hospitalization, against the background of
hypocoagulability, caused by the permanent use of anticoagulants
for cardiac pathology, the peptic ulcer was complicated by a spurt of
digestive hemorrhage, stopped endoscopically. Despite the
administration of a complex pathogenetic treatment, he had
repeated hemorrhage over 24 hours with indications for
emergency treatment without delay. Surgery: gastric antral
resection with short-loop gastro-jejunal anastomosis, anterograde
partial cholecystectomy, choledochotomy with removal of stones,
choledocho-duodenoanastomosis with transcystic drainage of the
bile ducts. Simple postoperative evolution. Patient discharged on
the 14th day after surgery. Biliary drain removed in 3 months.
Monitored 2 years. Evolution without complications.
Conclusions. The individualized selection of the
type and terms of surgery in an
elderly patient, with severe urgent
concomitants, is the key to success.
