[Mirizzi's syndrome as the cause of intrahepatic lithiasis. A clinical case]

The authors report a case of Mirizzi's syndrome that was the cause of intrahepatic lithiasis. The recurrence of acute episodes of cholecystitis may lead to a partial obstruction of hepato-choledochal duct through compression and phlogosis (Type 1 Mirizzi's syndrome); moreover, the compression of calculous material wedged in the cystic duct may also result in ischemic necrosis of the wall, thus causing a cholecystic-choledochal internal biliary fistula (Type 2 Mirizzi's syndrome). The authors analyse problems relating to the complications of gallbladder calculosis with indications for surgery at the first symptomatic manifestation, given that the recurrence of cholecystic inflammatory episodes provokes pathological conditions in the biliary tract that require major surgery with a consequent increase in mortality and morbidity, above all in elderly patients. The authors recommended performing a through intraoperative study to ensure the correct identification of intrahepatic lithiasis, given the difficulty of preoperative diagnosis. The objective of treatment is to suppress the lithogenic focus and ensure good biliary drainage.