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Updated: Feb 26, 2026
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Published on: May 2, 2025
Paediatric Mirizzi syndrome managed with laparoscopic, transcystic bile duct exploration and intraoperative ERCP
Nora E Siegler1,2, Nicholas J Iglesias3, Andres M Corona3
1DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, Florida, USA nxs1456@miami.edu.
Insights
A single-stage surgical and endoscopic approach effectively treated pediatric Mirizzi syndrome, resolving obstructive jaundice and avoiding repeat procedures. This combined technique offers an optimal solution for complex pediatric biliary pathology.
Area of Science:
- Hepatobiliary Surgery
- Pediatric Gastroenterology
- Endoscopic Retrograde Cholangiopancreatography
Background:
- Mirizzi syndrome, characterized by gallstone impaction causing biliary obstruction, is rare in children.
- Obstructive jaundice in pediatric patients necessitates prompt and effective management.
Purpose of the Study:
- To present a case of pediatric Mirizzi syndrome managed with a novel single-stage approach.
- To highlight the benefits of combining laparoscopic surgery and intraoperative ERCP.
Main Methods:
- Magnetic resonance cholangiopancreatography (MRCP) for diagnosis.
- Laparoscopic cholecystectomy with intraoperative cholangiography.
- Transcystic common bile duct exploration and intraoperative ERCP with biliary stent placement.
Main Results:
- Successful resolution of external common hepatic ductal compression and obstructive jaundice.
- Avoidance of repeat general anesthesia and delayed procedures.
- Complete stone clearance and successful stent removal postoperatively.
Conclusions:
- A single-stage combined surgical and endoscopic approach is feasible and advantageous for pediatric Mirizzi syndrome.
- This strategy optimizes management by minimizing patient burden and improving outcomes.
- Referral to specialized centers with expertise in advanced surgical endoscopy is recommended for complex pediatric biliary cases.
Abstract:
A female of middle childhood age presented with obstructive jaundice and was diagnosed with Mirizzi syndrome via magnetic resonance cholangiopancreatography. She underwent laparoscopic cholecystectomy with intraoperative cholangiography, which confirmed external common hepatic ductal compression by an impacted gallstone. In the same operative event, transcystic common bile duct exploration and intraoperative endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent placement were performed to achieve definitive stone clearance. This single-stage approach avoided repeat general anaesthesia and the need for delayed ERCP. The patient experienced transient postoperative fever but recovered well without further intervention. The stent was successfully removed 45 days postoperatively, with follow-up ERCP confirming resolution of biliary obstruction. This case highlights the feasibility and advantages of combining advanced endoscopic and surgical techniques to optimise management of paediatric Mirizzi syndrome in a single event. Referral to centres and surgeon familiarity with advanced surgical endoscopy is recommended for optimal care in paediatric patients with complex biliary pathology.
