Gallbladder malignancy in the setting of Mirizzi syndrome with bile duct involvement: a case report

Mirizzi syndrome is a rare complication of gallstone disease characterized by extrinsic compression of the common hepatic duct and is associated with an increased risk of gallbladder carcinoma. We report the case of an 83-year-old female who presented with altered mental status, cholestatic hepatic enzyme elevation, and obstructive jaundice. Computed tomography imaging demonstrated biliary ductal dilation with a proximal common bile duct stricture concerning for malignancy. Intraoperative findings during laparoscopic cholecystectomy confirmed Type I Mirizzi syndrome with suppurative cholecystitis. Histopathology revealed well-differentiated adenocarcinoma involving the gallbladder neck with positive margins. The patient subsequently underwent definitive resection with completion cholecystectomy, central hepatectomy, bile duct resection, periportal and perihepatic lymphadenectomy, and Roux-en-Y hepaticojejunostomy. This case highlights the diagnostic and operative challenges posed by Mirizzi syndrome-associated biliary malignancy and underscores the importance of multidisciplinary management in achieving successful oncologic resection.