Mirizzi syndrome and biliobiliary fistulas: roentgenologic appearance

Five cases of extrahepatic cholestasis caused by impaction of a voluminous gallstone in the neck of the gallbladder or the cystic duct are reported. The formation of a biliobiliary fistula is the rule. Percutaneous transhepatic cholangiography visualizes the fistulas and permits their classification into 2 groups: gallbladder to hepatic duct, and cystic to hepatic duct. Preoperative diagnosis permits the best resolutions of 2 problems encountered during surgery: (1) the tumor-like feature often produced by the cholecystitis can be ascribed to benign lithiasic etiology if the biliobiliary fistula is diagnosed in the preoperative phase; and (b) treatment by biliary plasty, which requires first opening the gallbladder and partial cholecystectomy, has to be achieved.