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 pathologies such as cholangiocarcinoma 2.
Fistulae can develop between the gallbladder and the common duct, and the stone may pass into the common duct.
Anatomical risk factors
A low insertion of the cystic duct into the common bile duct as well as a tortuous cystic duct are thought to be risk factors.
The stricture is smooth and often concave to the right.
The gallbladder wall may be diffusely thickened and may enhance with contrast.
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 first described by Pablo Luis Mirizzi (1893-1964), an Argentinian surgeon in a paper from 1940, although 1948 is often quoted, as in this year he published a paper in which it became widely-known 4,6. Mirizzi performed the first operative cholangiogram in 1931. He was named a Master Surgeon (Cirujano Maestro) in 1956 by the Argentinian Surgeons Society (Sociedad Argentina de Cirugía) 6.
- 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
- 6. Beltrán MA. Mirizzi syndrome: history, current knowledge and proposal of a simplified classification. (2012) World journal of gastroenterology. 18 (34): 4639-50. doi:10.3748/wjg.v18.i34.4639 - Pubmed