Unexpected Mirizzi anatomy: a major hazard to the common bile duct during laparoscopic cholecystectomy

Mirizzi's syndrome is described as an impaction of gallstone(s) in the infundibulum, Hartmann's pouch, or cystic duct in close proximity to the common hepatic duct, causing secondary inflammation, hepatic duct obstruction, and jaundice. This anatomical configuration can unexpectedly present itself during laparoscopic cholecystectomy without the associated clinical syndrome. Identification of the gallbladder-cystic duct junction may become impossible, leading to dangerous exposure of the common duct. The case presented here demonstrates the dangers and difficulties encountered with such anatomy. Increased awareness of this rare and unusual configuration may help in avoiding injuries to the biliary tree during laparoscopic cholecystectomy.