Mirizzi syndrome
Updates to Article Attributes
The Mirizzi syndrome refers to an uncommon phenomenon which results in extrinsic compression of an extrahepatic biliary duct from one or more calculi within the cystic duct or gallbladder. It is a functional hepatic syndrome but can often present with biliary duct dilatation and can mimic other hepatobiliary pathologies such as cholangiocarcinoma 2.
Clinical presentation
Patients may present with recurrent episodes of jaundice and cholangitis. It can be associated with acute cholecystitis.
Fistulae can develop between the gallbladder and the common duct, and the stone may pass into the common duct.
Pathology
Anatomical risk factors
A low insertion of the cystic duct into the common bile duct as well as a tortuous cystic duct are thought to be risk factors.
Radiographic features
ERCP
The stricture is smooth and often concave to the right.
CT
The gallbladder wall may be diffusely thickened and may enhance with contrast.
MRI
MRCP classically shows a large impacted gallstone in the gallbladder neck and dilated extrahepatic ducts which gradually taper to a normal common bile duct.
History and etymology
It was first described by Pablo Luis Mirizzi (1893-1964), an Argentinian surgeon in a paper from 1940, although 1948 is often quoted, as in this year he published a paper in which it became widely-known 4,6. Mirizzi performed the first operative cholangiogram in 1931. He was named a Master Surgeon (Cirujano Maestro) in 1956 by the Argentinian Surgeons Society (Sociedad Argentina de Cirugía) 6.
-<p>The <strong>Mirizzi syndrome</strong> refers to an uncommon phenomenon which results in extrinsic compression of an extrahepatic biliary duct from one or more calculi within the <a title="Cystic duct" href="/articles/cystic-duct">cystic duct</a> or <a href="/articles/gallbladder">gallbladder</a>. It is a functional hepatic syndrome but can often present with <a title="Biliary dilatation" href="/articles/bile-duct-dilatation-differential">biliary duct dilatation</a> and can mimic other hepatobiliary pathologies such as <a href="/articles/cholangiocarcinoma">cholangiocarcinoma</a> <sup>2</sup>.</p><h4>Clinical presentation</h4><p>Patients may present with recurrent episodes of <a href="/articles/jaundice">jaundice</a> and <a title="Cholangitis" href="/articles/cholangitis">cholangitis</a>. It can be associated with <a href="/articles/cholecystitis">acute cholecystitis</a>. </p><p>Fistulae can develop between the gallbladder and the common duct, and the stone may pass into the common duct. </p><h4>Pathology</h4><h5>Anatomical risk factors</h5><p>A low insertion of the cystic duct into the <a title="Common bile duct" href="/articles/common-bile-duct">common bile duct</a> as well as a tortuous cystic duct are thought to be risk factors.</p><h4>Radiographic features</h4><h5>ERCP </h5><p>The stricture is smooth and often concave to the right.</p><h5>CT</h5><p>The gallbladder wall may be diffusely thickened and may enhance with contrast.</p><h5>MRI</h5><p><a href="/articles/magnetic-resonance-cholangiopancreatography">MRCP</a> classically shows a large impacted gallstone in the gallbladder neck and dilated extrahepatic ducts which gradually taper to a normal common bile duct.</p><h4>History and etymology</h4><p>It was first described by <strong>Pablo Luis Mirizzi</strong> (1893-1964), an Argentinian surgeon in a paper from 1940, although 1948 is often quoted, as in this year he published a paper in which it became widely-known <sup>4,6</sup>. Mirizzi performed the first operative cholangiogram in 1931. He was named a Master Surgeon (Cirujano Maestro) in 1956 by the Argentinian Surgeons Society (Sociedad Argentina de Cirugía) <sup>6</sup>.</p>- +<p>The <strong>Mirizzi syndrome</strong> refers to an uncommon phenomenon which results in extrinsic compression of an extrahepatic biliary duct from one or more calculi within the <a href="/articles/cystic-duct">cystic duct</a> or <a href="/articles/gallbladder">gallbladder</a>. It is a functional hepatic syndrome but can often present with <a href="/articles/bile-duct-dilatation-differential">biliary duct dilatation</a> and can mimic other hepatobiliary pathologies such as <a href="/articles/cholangiocarcinoma">cholangiocarcinoma</a> <sup>2</sup>.</p><h4>Clinical presentation</h4><p>Patients may present with recurrent episodes of <a href="/articles/jaundice">jaundice</a> and <a href="/articles/cholangitis">cholangitis</a>. It can be associated with <a href="/articles/cholecystitis">acute cholecystitis</a>. </p><p>Fistulae can develop between the gallbladder and the common duct, and the stone may pass into the common duct. </p><h4>Pathology</h4><h5>Anatomical risk factors</h5><p>A low insertion of the cystic duct into the <a href="/articles/common-bile-duct">common bile duct</a> as well as a tortuous cystic duct are thought to be risk factors.</p><h4>Radiographic features</h4><h5>ERCP </h5><p>The stricture is smooth and often concave to the right.</p><h5>CT</h5><p>The gallbladder wall may be diffusely thickened and may enhance with contrast.</p><h5>MRI</h5><p><a href="/articles/magnetic-resonance-cholangiopancreatography">MRCP</a> classically shows a large impacted gallstone in the gallbladder neck and dilated extrahepatic ducts which gradually taper to a normal common bile duct.</p><h4>History and etymology</h4><p>It was first described by <strong>Pablo Luis Mirizzi</strong> (1893-1964), an Argentinian surgeon in a paper from 1940, although 1948 is often quoted, as in this year he published a paper in which it became widely-known <sup>4,6</sup>. Mirizzi performed the first operative cholangiogram in 1931. He was named a Master Surgeon (Cirujano Maestro) in 1956 by the Argentinian Surgeons Society (Sociedad Argentina de Cirugía) <sup>6</sup>.</p>
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