The Mirizzi syndrome refers to an uncommon phenomenon which results in extrinsic compression of a extra-hepatic billiary duct from one or more calculi within the cystic duct or gallbladder. It is a functional hepatic syndrome but can often present with biliary duct dilatation and can mimic other hepatobiliary pathology such as cholangiocarcinoma 2.
Anatomical risk factors
A low insertion of the cystic duct into the common bile duct as well as a tortuous cystic cyst are thought to be risk factors.
Patients may present with recurrent episodes of jaundice and cholangitis. It can be associated with acute cholecystitis.
Fistulae can develop between the gallbladder and the common duct, and the stone may pass into the common duct.
The gallbladder wall may be diffusely thickened and may enhance with contrast.
Fluoroscopy - ERCP
The stricture is smooth and often concave to the right as seen on ERCP
MRI - MRCP
Classically shows a large impacted gallstone in the gallbladder neck and dilated extra hepatic ducts which gradually taper to a normal common bile duct.
It was initially described by Pablo Louis Mirizzi - Argentinian surgeon (1893-1964) in 1948 4
- 1.Fulcher AS, Turner MA, Capps GW. MR cholangiography: technical advances and clinical applications. Radiographics. 19 (1): 25-41. Radiographics (full text) - Pubmed citation
- 2.Menias CO, Surabhi VR, Prasad SR et-al. Mimics of cholangiocarcinoma: spectrum of disease. Radiographics. 28 (4): 1115-29. doi:10.1148/rg.284075148 - Pubmed citation
- 3. Becker CD, Hassler H, Terrier F. Preoperative diagnosis of the Mirizzi syndrome: limitations of sonography and computed tomography. AJR Am J Roentgenol. 1984;143 (3): 591-6. AJR Am J Roentgenol (abstract) - Pubmed citation
- 4. Keogan MT, Paulson EK. Gastrointestinal case of the day. Obturator hernia causing small bowel obstruction - Mirizzi syndrome Case 3. AJR Am J Roentgenol. 1995;165 (1): 192-3. AJR Am J Roentgenol (citation) - Pubmed citation
- 5. Cruz FO, Barriga P, Tocornal J et-al. Radiology of the Mirizzi syndrome: diagnostic importance of the transhepatic cholangiogram. Gastrointest Radiol. 1983;8 (3): 249-53. - Pubmed citation
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