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Mirizzi syndrome

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.

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.

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. 

Radiographic features

CT

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.  

Etymology

It was initially described by Pablo Louis Mirizzi - Argentinian surgeon (1893-1964) in 1948 4

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