{"id":4497,"date":"2017-10-23T08:15:51","date_gmt":"2017-10-23T08:15:51","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/mirizzi\/"},"modified":"2022-06-15T14:28:55","modified_gmt":"2022-06-15T14:28:55","slug":"mirizzi","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/mirizzi\/","title":{"rendered":"S\u00edndrome de Mirizzi"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Em 1948, o cirurgi\u00e3o argentino Pablo L. Mirizzi descreveu um paciente com obstru\u00e7\u00e3o parcial do hepatocol\u00e9doco secund\u00e1rio a c\u00e1lculo biliar impactado no infund\u00edbulo da ves\u00edcula biliar associado \u00e0 resposta inflamat\u00f3ria envolvendo o ducto c\u00edstico e o ducto hep\u00e1tico comum. Essa apresenta\u00e7\u00e3o tornou-se conhecida como S\u00edndrome de Mirizzi (SM).<\/span><\/p>\n<div id=\"attachment_10161\" style=\"width: 160px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" aria-describedby=\"caption-attachment-10161\" class=\"wp-image-10161 size-full\" title=\"Pablo Luis Mirizzi\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2017\/10\/pablo-mirizzi.jpeg\" alt=\"Pablo Luis Mirizzi\" width=\"150\" height=\"200\"><p id=\"caption-attachment-10161\" class=\"wp-caption-text\">Pablo Luis Mirizzi (1893-1964)<\/p><\/div>\n<p><span style=\"font-weight: 400;\">Inicialmente, Mirizzi caracterizou a s\u00edndrome por associa\u00e7\u00e3o dos seguintes fatores: ducto c\u00edstico com trajeto paralelo ao ducto hep\u00e1tico comum, c\u00e1lculos impactados no ducto c\u00edstico ou no infund\u00edbulo da ves\u00edcula biliar, obstru\u00e7\u00e3o mec\u00e2nica do ducto hep\u00e1tico comum por c\u00e1lculos ou secund\u00e1rio \u00e0 inflama\u00e7\u00e3o, icter\u00edcia cont\u00ednua ou intermitente e colangite recorrente.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Atualmente, ela compreende um espectro de apresenta\u00e7\u00f5es que variam desde a compress\u00e3o extr\u00ednseca do hepatocol\u00e9doco at\u00e9 a presen\u00e7a de f\u00edstula colecistobiliar.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u00c9 uma complica\u00e7\u00e3o relativamente rara, ocorrendo em 0,05% \u2013 3,95% dos pacientes com colelit\u00edase.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Possui maior preval\u00eancia em mulheres com idade entre 21 e 90 anos, provavelmente um reflexo da preponder\u00e2ncia de lit\u00edase biliar nesse grupo.<\/span><\/p>\n<h2><b>Quadro cl\u00ednico e laboratorial<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">O quadro cl\u00ednico-laboratorial da SM n\u00e3o \u00e9 espec\u00edfico. Na anamnese, normalmente o paciente relata colelit\u00edase de longa data, epis\u00f3dios de icter\u00edcia obstrutiva e passado de colecistite aguda e\/ou colangite.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Os sinais e sintomas referidos geralmente incluem:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">dor abdominal em hipoc\u00f4ndrio direito e\/ou epig\u00e1strio;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">icter\u00edcia;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">n\u00e1useas e v\u00f4mitos;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">col\u00faria;<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">febre.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Quanto aos exames laboratoriais, as transaminases costumam estar elevadas, bem como a bilirrubina direta, a fosfatase alcalina e a gama- GT.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Cerca de 80% dos pacientes com SM apresentam icter\u00edcia, dor abdominal e altera\u00e7\u00f5es das provas de fun\u00e7\u00e3o hep\u00e1tica.<\/span><\/p>\n<h2><b>Exames de imagem<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">A ultrassonografia e a tomografia computadorizada de abdome podem sugerir o diagn\u00f3stico de SM ao revelar c\u00e1lculo(s) fixo(s) na \u00e1rea do infund\u00edbulo, pr\u00f3ximo \u00e0 jun\u00e7\u00e3o do ducto c\u00edstico com o hep\u00e1tico comum, e dilata\u00e7\u00e3o das vias biliares acima do local da compress\u00e3o.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A colangiopancreatografia retr\u00f3grada endosc\u00f3pica (CPRE) tamb\u00e9m pode revelar compress\u00e3o ou estreitamento do hepatocol\u00e9doco.<\/span><\/p>\n<div id=\"attachment_8296\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2017\/09\/mirizzi.jpg\" data-rel=\"penci-gallery-image-content\" ><img fetchpriority=\"high\" decoding=\"async\" aria-describedby=\"caption-attachment-8296\" class=\"wp-image-8296 size-medium\" title=\"colangiopancreatografia retr\u00f3grada endosc\u00f3pica (CPRE)\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/mirizzi.jpg\" alt=\"colangiopancreatografia retr\u00f3grada endosc\u00f3pica (CPRE)\" width=\"300\" height=\"278\"><\/a><p id=\"caption-attachment-8296\" class=\"wp-caption-text\">Colangiopancreatografia retr\u00f3grada endosc\u00f3pica (CPRE)<\/p><\/div>\n<p><span style=\"font-weight: 400;\">A ecoendoscopia no diagn\u00f3stico da coledocolit\u00edase, independentemente do tamanho do c\u00e1lculo ou do di\u00e2metro coledociano, \u00e9 um teste diagn\u00f3stico mais acurado do que a CPRE para a detec\u00e7\u00e3o de c\u00e1lculo na via biliar principal.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Para o diagn\u00f3stico da SM, a ecoendoscopia apresenta uma sensibilidade de 97% e especificidade de 100%.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A colangioresson\u00e2ncia pode demonstrar com precis\u00e3o a presen\u00e7a de dilata\u00e7\u00e3o biliar, o grau de obstru\u00e7\u00e3o, a localiza\u00e7\u00e3o intra ou extraluminal dos c\u00e1lculos, podendo revelar ainda altera\u00e7\u00f5es anat\u00f4micas, como f\u00edstulas e malforma\u00e7\u00f5es.<\/span><\/p>\n<h2><b>Classifica\u00e7\u00e3o<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">A s\u00edndrome de Mirizzi, que antes era classificada em apenas quatro tipos, atualmente, inclui mais um, o tipo V, que compreende a f\u00edstula colecistoent\u00e9rica.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Os tipos s\u00e3o:<\/span><\/p>\n<p><b>I)<\/b><span style=\"font-weight: 400;\"> compress\u00e3o extr\u00ednseca do ducto hepacol\u00e9doco por c\u00e1lculo no infund\u00edbulo da ves\u00edcula ou no ducto c\u00edstico;<\/span><\/p>\n<p><b>II)<\/b><span style=\"font-weight: 400;\"> presen\u00e7a de f\u00edstula colecistobiliar com eros\u00e3o de di\u00e2metro inferior a 1\/3 da circunfer\u00eancia do ducto hepacol\u00e9doco;<\/span><\/p>\n<p><b>III)<\/b><span style=\"font-weight: 400;\"> presen\u00e7a de f\u00edstula colecistobiliar com di\u00e2metro superior a 2\/3 da circunfer\u00eancia do ducto hepacol\u00e9doco;<\/span><\/p>\n<p><b>IV)<\/b><span style=\"font-weight: 400;\"> presen\u00e7a de f\u00edstula colecistobiliar que envolve toda a circunfer\u00eancia do ducto hepacol\u00e9doco;<\/span><\/p>\n<p><b>V)<\/b><span style=\"font-weight: 400;\"> qualquer tipo, mais f\u00edstula colecistoent\u00e9rica (<\/span><b>Va:<\/b><span style=\"font-weight: 400;\"> sem \u00edleo biliar e <\/span><b>Vb:<\/b><span style=\"font-weight: 400;\"> com \u00edleo biliar).<\/span><\/p>\n<div id=\"attachment_10229\" style=\"width: 310px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" aria-describedby=\"caption-attachment-10229\" class=\"wp-image-10229 size-medium\" title=\"tipos de classifica\u00e7\u00e3o s\u00edndrome de Mirizzi\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2017\/10\/csendes-300x300.png\" alt=\"tipos de classifica\u00e7\u00e3o s\u00edndrome de Mirizzi\" width=\"300\" height=\"300\" srcset=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2017\/10\/csendes-300x300.png 300w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2017\/10\/csendes-150x150.png 150w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2017\/10\/csendes-70x70.png 70w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2017\/10\/csendes-585x585.png 585w, https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2017\/10\/csendes.png 768w\" sizes=\"(max-width: 300px) 100vw, 300px\" \/><p id=\"caption-attachment-10229\" class=\"wp-caption-text\">Classifica\u00e7\u00e3o de Csendes para a s\u00edndrome de Mirizzi. Modificado de Lacerda PS, et al. Mirizzi syndrome: a surgical challenge. Arq Bras Cir Dig. 2014.<\/p><\/div>\n<h2><b>Tratamento<\/b><\/h2>\n<p><span style=\"font-weight: 400;\">Os casos de Mirizzi tipo I, ou seja, sem f\u00edstula colecistobiliar, podem ser tratados pela colecistectomia cl\u00e1ssica. Por\u00e9m, em casos de extenso processo inflamat\u00f3rio, a colecistectomia subtotal com remo\u00e7\u00e3o dos c\u00e1lculos pode ser mais adequada.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Mirizzi II\/III (f\u00edstula colecistobiliar): abordagem dos pacientes com f\u00edstula colecistobiliar envolve colecistectomia subtotal fundo-c\u00edstica. A ves\u00edcula biliar deve ser removida deixando um remanescente de parede medindo cerca de 5-10 mm ao redor da f\u00edstula colecistobiliar, a fim de permitir a coledocoplastia do ducto biliar destru\u00eddo. A explora\u00e7\u00e3o do col\u00e9doco deve ser sempre realizada usando uma incis\u00e3o distal \u00e0 f\u00edstula e protegida por um tubo Kehr.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">No tipo IV, devido \u00e0 extensa destrui\u00e7\u00e3o da via biliar, o tratamento consiste em anastomose bilioenterica.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">No tipo V, deve ser realizada a sutura da v\u00edscera acometida.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A CPRE e a colangioscopia podem ser realizadas tamb\u00e9m como t\u00e9cnicas alternativas de tratamento em pacientes sem condi\u00e7\u00f5es cir\u00fargicas.<\/span><\/p>\n<h2><b>Como citar este artigo<\/b><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2017\/09\/mirizzi1.png\"><br \/>\n<\/a><\/h2>\n<p><span style=\"font-weight: 400;\">Ruiz RF, Martins B. S\u00edndrome de Mirizzi. Endoscopia Terap\u00eautica; 2021. Dispon\u00edvel em: <\/span><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/mirizzi\/\"><span style=\"font-weight: 400;\">https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/mirizzi\/<\/span><\/a><\/p>\n<h2><b>Refer\u00eancias<\/b><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2017\/09\/mirizzi1.png\"><br \/>\n<\/a><\/h2>\n<ol>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Safioleas M, et al. Mirizzi Syndrome: an unexpected problem of cholelithiasis. Our experience with 27 cases International Seminars in Surgical Oncology 2008;5:12.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Waisberg J, et al. Benign Obstruction of the common hepatic duct (Mirizzi Syndrome): diagnosis and operative management. Arq Gastroenterol 2005;42(1).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Beltran MA, Csendes A, Cruces Ks. The Relationship of Mirizzi Syndrome and Cholecystoenteric Fistula: Validation of a Modified Classification. World J Surg 2008; 32:2237-2243.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Fonseca Neto OCL, Pedrosa MGL, Miranda Al. Surgical management of Mirizzi syndrome. ABCD Arq Bras Cir Dig. 2008;21(2):51-4.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Machado MAC, et al. Colecistectomia Videolaparosc\u00f3pica em paciente com S\u00edndrome de Mirizzi. Rev Hosp Clin Fac Med S Paulo 1997;52(6):324-327.<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">Acesse o <\/span><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/\"><span style=\"font-weight: 400;\">Endoscopia Terap\u00eautica<\/span><\/a><span style=\"font-weight: 400;\"> para tomar contato com mais <\/span><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/artigos-comentados\/\"><span style=\"font-weight: 400;\">artigos comentados<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntos-gerais\/\"><span style=\"font-weight: 400;\">assuntos gerais<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/casos-clinicos\/\"><span style=\"font-weight: 400;\">casos cl\u00ednicos<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/quiz\/\"><span style=\"font-weight: 400;\">quizzes<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/classificacoes\/\"><span style=\"font-weight: 400;\">classifica\u00e7\u00f5es<\/span><\/a><span style=\"font-weight: 400;\"> e mais!<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Em 1948, o cirurgi\u00e3o argentino Pablo L. Mirizzi descreveu um paciente com obstru\u00e7\u00e3o parcial&hellip;<\/p>\n","protected":false},"author":4256,"featured_media":4495,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[151],"tags":[299,300,298],"ano":[276],"tipo":[155],"volume":[147],"class_list":["post-4497","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-assuntosgerais","tag-colangiopancreatografia","tag-endoscopica","tag-sindrome-de-mirizzi","ano-276","tipo-cpre","volume-volume-ii"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>S\u00edndrome de Mirizzi - Endoscopia Terap\u00eautica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/assuntosgerais\/mirizzi\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"S\u00edndrome de Mirizzi\" \/>\n<meta property=\"og:description\" content=\"Em 1948, o cirurgi\u00e3o argentino Pablo L. 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