edad, quien ingresa por presentar dolor agudo, tipo cólico en hipocondrio derecho, con irradiación a la espalda, de 3 días de evolución. Nausea y vómitos.
• Refiere haber presentado un cuadro parecido de dolor hace 3 meses.
Antecedentes• AHF. Negados.• APP. Refiere ingreso previo hace
1 año por litiasis vesicular. • Exploración física. Paciente con
ictericia, Murphy +.• Actualmente cursando su 2 día
de estancia hospitalaria presentando 2 picos febriles.
Mary Ann, MD. Ann S. Fulcher, MD. The Cyst Duct: Normal Anatomy and Disease Processes. Radiographics 2001.
ANATOMÍA DEL NORMAL DEL TRACTO BILIAR
Válvulas de Heister
Hector Dominguez Hernandez
Drawing illustrates the normal biliary tract. The cystic duct (arrows) connects the gall- bladder to the extra- hepatic bile duct and usually enters from the right approxi- mately halfway be- tween the porta hepatis and the am- pulla of Vater. It also contains the valves of Heister.
Hector Dominguez Hernandez
Normal cystic duct anatomy. ERCP image shows a normal-caliber cystic duct (solid arrow). Note the undulating contour of the duct produced by the valves of Heister. An air bubble (open arrow) is noted in the common bile duct.
Mary Ann, MD. Ann S. Fulcher, MD. The Cyst Duct: Normal Anatomy and Disease Processes. Radiographics 2001.
ANATOMÍA DEL NORMAL DEL TRACTO BILIAR
Mide 2-4cm de longitud.Diámetro 1 a 5mm.Se une a la vía biliar extrahepática en su borde derecho en un 49.9% de los casos.
Hector Dominguez Hernandez
Drawing illustrates the normal biliary tract. The cystic duct (arrows) connects the gall- bladder to the extra- hepatic bile duct and usually enters from the right approxi- mately halfway be- tween the porta hepatis and the am- pulla of Vater. It also contains the valves of Heister.
Mary Ann, MD. Ann S. Fulcher, MD. The Cyst Duct: Normal Anatomy and Disease Processes. Radiographics 2001.
Hector Dominguez Hernandez
Normal cystic duct anatomy. (a) Oblique US image of the right upper quadrant shows the site of entryof the cystic duct (arrow) into the middle one-third of the extrahepatic bile duct (bd). (b) Sagittal US image of the right upper quadrant demonstrates the cystic duct (curved arrow), gallbladder neck (straight arrow), and body of the gallbladder (g)
Mary Ann, MD. Ann S. Fulcher, MD. The Cyst Duct: Normal Anatomy and Disease Processes. Radiographics 2001.
Hector Dominguez Hernandez
NoRMAL CYSTIC DUCT ANATOMY. rowheads) extending from the gallbladder (g). (5) Coronal oblique MR cholangiopancreatogram demonstrates the normal cystic duct (arrow) connecting the gallbladder to the extrahepatic bile duct (arrowhead). Gallbladder calculi are also present.
• 95% de los casos, una colecistitis es causada por un lito que obstruye la luz del conducto cístico.
• Los litos <3mm pueden pasar rápidamente este conducto.
• Cuando existe una obstrucción litiásica, la inflamación y distención de la vesícula puede resulta en isquemia y necrosis transmural si la obstrucción persiste.
Mary Ann, MD. Ann S. Fulcher, MD. The Cyst Duct: Normal Anatomy and Disease Processes. Radiographics 2001.
Mary Ann, MD. Ann S. Fulcher, MD. The Cyst Duct: Normal Anatomy and Disease Processes. Radiographics 2001.
Únicamente el 15 al 20% de los litos son lo suficientemente densos para permitir la detección por radiografías.
VPP: 92%VPN:95% CT: 79%.
Hector Dominguez Hernandez
Calculous disease. (a) Conventional anteropos- terior radiograph of the abdomen obtained in a 54-year-old man shows a calcified stone in the expected location in the cystic duct (arrow) and demonstrates milk of calcium bile in the gallbladder (arrowheads). (b) Sagittal US image of the gallbladder obtained in the same patient demonstrates a stone impacted in the cystic duct (arrow). Acoustic shadow- ing is noted posterior to the stone (arrowheads). (c) PTC image obtained in a 31-year-old man reveals multiple cystic duct stones (solid arrows) as well as a stone impacted in the distal bile duct (open arrow). (d) Coronal oblique MR chol- angiopancreatogram obtained in a 33-year-old man shows a stone in the cystic duct (arrow). Stones are also present in the gallbladder (g).
100% SENSIBILIDAD
Mary Ann, MD. Ann S. Fulcher, MD. The Cyst Duct: Normal Anatomy and Disease Processes. Radiographics 2001.
Mary Ann, MD. Ann S. Fulcher, MD. The Cyst Duct: Normal Anatomy and Disease Processes. Radiographics 2001.
SX DE MIRIZZI
Ocurre cuando un lito vesicular impactado en el cístico condiciona compresión extrínseca y obstrucción del conducto hepático.
Mary Ann, MD. Ann S. Fulcher, MD. The Cyst Duct: Normal Anatomy and Disease Processes. Radiographics 2001.
Hector Dominguez Hernandez
Mirizzi syndrome in a 46-year-old woman. (a) Co- ronal MR cholangiopancreatogram reveals a 1.2-cm calculus (ar- row) resulting in biliary dilatation. Gallbladder calculi are also noted (arrowheads). (b) Coronal MR cholangiopancreatogram obtained 5 mm anterior to a shows two calculi (arrowheads) in the dilated cystic duct, which parallels the extrahepatic bile duct. The inferior calculus corresponds to the ductal calculus seen in a. This calculus eroded through the wall of the cystic duct into the extrahepatic bile duct, bridging the two structures and resulting in compression and obstruction of the common hepatic duct. (c) ERCP image demonstrates a calculus in the cystic duct (ar- rowhead) as well as the larger, more inferior calculus (arrow) re- sulting in obstruction of the bile duct (bd). (Figure 16 reprinted, with permission, from reference 35.)
Mary Ann, MD. Ann S. Fulcher, MD. The Cyst Duct: Normal Anatomy and Disease Processes. Radiographics 2001.
Resolución laparoscópica de litiasis vesicular complicada colecistobiliar. Síndrome de Mirizzi. Omaira Rodriguez, Alexis Sanchez, et al. RFM Diciembre 2009
DIAGNÓSTICO
COLEDOCOLITIASIS
VESICULA BILIAR ESCLEROATRÓFICA
AUSENCIA DE CONDUCTO CÍSTICO
SX DE MIRIZZI III
COLANGITIS
VESICULA BILIAR ESCLEROATRÓFICA
AUSENCIA DE CONDUCTO CÍSTICO
MIRIZZI III/ COLEDOCOLITIASIS
MIRIZZI III/ COLEDOCOLITIASIS
Mirizzi Sindrome: History, current Knowledge and proposal of a simplified classification. Beltrán A. Marcelo. Work Journal of Gastroenterology. September 2012