Mirizzi syndrome

Case contributed by Zareena Ansari
Diagnosis almost certain


Severe epigastric colicky pain since two days associated with nausea.

Patient Data

Age: 35 years
Gender: Female

Patient was brought in for an ultrasound from the ER.

Abdominal ultrasound revealed a large 12 mm calculus in the terminal end of the cystic duct. The calculus was seen to externally compress the common hepatic duct with resultant biliary obstruction. There is mild proximal dilatation of the right and left hepatic ducts, the common hepatic duct and central IHBR along with overdistended gall bladder. The CBD distal to the calculus is normal in caliber.

Case Discussion

Mirizzi syndrome is a rare complication of gallstone disease in which a gallstone becomes impacted in the cystic duct or neck of the gallbladder causing compression of the common bile duct (CBD) or common hepatic duct, resulting in proximal obstruction. The patient may present initially with colicky epigastric pain or manifest with hyperbilirubinemia (jaundice). The obstructive jaundice can be caused by direct extrinsic compression of CHD/CBD by the stone or from fibrosis of the same caused by chronic inflammation. A cholecystocholedochal fistula can occur as a further complication to this condition if left untreated.

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