Mirizzi syndrome

The Mirizzi syndrome refers to an uncommon phenomenon which results in extrinsic compression of an extrahepatic biliary 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.

Clinical presentation

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. 

Pathology

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.

Radiographic features

ERCP 

The stricture is smooth and often concave to the right.

CT

The gallbladder wall may be diffusely thickened and may enhance with contrast.

MRI
  • MRCP
    • classically shows a large impacted gallstone in the gallbladder neck and dilated extrahepatic ducts which gradually taper to a normal common bile duct

History and etymology

It was initially described by Pablo Luis Mirizzi (1893-1964), an Argentinian surgeon in 1948 4. Mirizzi performed the first operative cholangiogram in 1931. He was named a master surgeon in 1956 by the Argentinian Surgeons Society. 

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Article Information

rID: 7971
System: Hepatobiliary
Synonyms or Alternate Spellings:
  • Mirizzi's syndrome
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    Case 1
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    Case 2: from stone in cystic duct stump
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