Mirizzi's syndrome is a rare cause of acquired jaundice. It is caused by chronic cholecystitis and large gallstones resulting in stenosis of the common bile duct.

Epidemiology

Mirizzi syndrome occurs in approximately 0.7-1.4% of all patients undergoing cholecystectomy and in 0.1% of all patients with gallstone disease.

Pathophysiology

Multiple and large gallstones can reside chronically in the Hartmann's pouch [1] of the gallbladder, causing inflammation, necrosis, scarring and ultimately fistula formation into the adjacent common bile duct (CBD). As a result, the CBD becomes obstructed by either scar or stone, resulting in jaundice.

Features

Mirizzi syndrome has no consistent or unique clinical features that distinguish it from other more common forms of obstructive jaundice. Symptoms of recurrent cholangitis, jaundice, right upper quadrant pain, and elevated bilirubin and alkaline phosphatase may or may not be present. Acute presentations of the syndrome include pancreatitis or cholecystitis. It may be mistaken for pancreatic cancer or cholangiocarcinoma.

Diagnosis

CT scan or ultrasonography usually make the diagnosis. Often, ERCP is used to define the lesion anatomically prior to surgery.

Treatment

The treatment of choice is surgical excision of the gallbladder, and reconsgtruction of the common hepatic duct and common bile duct.