An uncommon cause of biliary obstruction (Mirizzi syndrome): report of five cases

Mirizzi syndrome is a rare form of common hepatic duct obstruction resulting from an inflammatory response secondary to a gallstone impacted in the cystic duct or neck of the gallbladder. Herein, we report five patients with this syndrome. Clinically, all patients had prominent jaundice. Ultrasound examination showed a large stone in the neck of the gallbladder. Endoscopic retrograde cholangiopancreaticography demonstrated a filling defect in the biliary tract the cystic duct level. Four patients possessed cholecystobiliary fistulas. Two patients also had common bile duct stones. Operations included simple cholecystectomy in one patient, and partial cholecystectomy with choledochoplasty with the use of gallbladder flap and T-tube insertion in the other four patients. All patients were uneventfully discharged. If a patient has clinical obstructive jaundice, a huge stone encased in the neck of the gallbladder and a filling defect of the biliary tract at the cystic duct level shown on a cholangiogram, Mirizzi syndrome must be considered. A cholecystobiliary fistula will probably be present if the cholangiogram further reveals an excavated filling defect or a block of the common duct; in this case, partial cholecystectomy and choledochoplasty with a gallbladder flap is the treatment of choice. Mirizzi syndrome is a contraindication for laparoscopic cholecystectomy which can easily result in common duct injury.