Synopsis
Recognise two uncommon mechanical complications of gallstones, define altered biliary or intestinal anatomy, and avoid routine operative approaches that increase duct or bowel injury.
- Mirizzi syndrome is extrinsic common-hepatic-duct compression or erosion by an impacted gallbladder-neck or cystic-duct stone.
- Suspect Mirizzi when gallstones accompany obstructive jaundice and proximal duct dilatation but the distal common duct is not comparably enlarged.
- Map anatomy with ultrasound followed by MRCP, CT, EUS or ERCP according to stability and need for drainage; careless cholecystectomy risks dividing an adherent bile duct.
Key red flags
Jaundice with fever or hypotension in suspected Mirizzi syndrome indicates infected obstruction requiring urgent drainage planning.
Peritonism, closed-loop features, rising lactate or free gas in gallstone ileus suggests bowel ischaemia or perforation and demands emergency operation.
Peritonism, continuous severe pain, metabolic deterioration or free gas suggests ischaemia or perforation requiring immediate surgery.
Investigation priorities
Characterise obstruction and infection in suspected Mirizzi syndrome.
Management branches
A patient with gallstones develops jaundice and fever; imaging shows an impacted neck stone, dilated intrahepatic ducts and a relatively normal distal common duct.
- Recognise probable Mirizzi syndrome with cholangitis and begin sepsis treatment and urgent biliary drainage planning.
- Use MRCP or therapeutic ERCP to define and decompress the anatomy according to stability and local expertise.