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Mirizzi Syndrome: A Case Report

J M Muthuuri


The classical Mirizzi Syndrome described by P. L. Mirizzi in 1948 is characterized by a cholecystocholedochal fistula arising from a calculus in the cystic duct that erodes into the common hepatic duct. The gall bladder eventually collapses due to fibrosis while the terminal bile ducts become dilated. A calculus is usually found in the cystic duct or in the Hartman’s pouch. This presents an unusual and specific cause of obstruction of the terminal bile ducts. Patients present with obstructive jaundice. Cholangiography shows narrowing of the common bile duct at the porta hepatis, which can have the appearance of a cholangiocarcinoma. Preoperative ERCP is helpful in deciding the best type of operative approach. The true pathology is eventually identified at surgery. The operation is often difficult because of severe inflammation and fibrosis. For cholecystocholedochal fistula, a cholecystoduodenostomy is a safer operation. In more complex situations a choledochoplasty (using part of the gallbladder wall) or a choledochojejunostomy Rouxen-Y may be required.