Treatment of Mirizzi Syndrome with Gallstone Ileus (Type Vb: Cholecystoenteric Fistula)
Mirizzi syndrome type Vb is a complex biliary presentation in which an abnormal communication between the gallbladder and the bowel — a cholecystoenteric fistula — has formed, complicated by gallstone ileus.
Clinical Scenario
Gallstone ileus arising from a cholecystoenteric fistula in Mirizzi syndrome type Vb. This anatomically advanced variant requires specific surgical planning that differs from earlier Mirizzi types.
Surgical Approach
Management involves a surgical approach addressing both the fistula and the obstructing stone — either in a single operative stage or, in selected patients, as a staged procedure. The full protocol specifies which approach applies to which patient profile, including criteria for high-risk cases.
References
DOI: 10.5772/intechopen.1010159
- Type Vb: Cholecystoenteric fistula with gallstone ileus.
- Surgical management of type Vb (gallstone ileus) offers two options: a one-stage procedure, which involves cholecystectomy along with fistula repair and stone extraction, and a two-stage procedure, where stone extraction is performed first, followed by cholecystectomy and fistula repair at a later time.
- However, it is often recommended for high-risk patients with multiple comorbidities, shock, or significant intra-abdominal inflammation or adhesions.
View source ↗