Mirizzi syndrome with a double biliary fistula

Mirizzi syndrome is a partial obstruction of the biliary tree caused by a stone impacted in the cystic duct, with or without development of a cholecystobiliary fistula. Clinical signs are non-specific and suggest at first an obstructive jaundice. We describe a patient with a type I Mirizzi syndrome with a cholecystocolic and a cholecysto-internal biliary fistula. The diagnosis was suggested by ultrasonography and tomodensitometry, and confirmed by endoscopic retrograde cholangiopancreatography. A partial cholecystectomy with a Roux-en-Y hepaticojejunostomy reconstruction was performed. A review of the literature covering its clinical presentation, diagnosis and surgical treatment is presented.