Mirizzi Syndrome involves an impacted gallstone in the neck of the gallbladder or cystic duct with jaundice. It can be classified based on the anatomy and presence or absence of a fistula.
The jaundice is due to extrinsic compression of the common bile duct by the impacted stone associated with inflammation.
Cholecystocholedochal Fistula
Site of Stone Impaction
Type
absent
in a long cystic duct running parallel to the common bile duct
IA
absent
in cystic duct or Hartmann's pouch
IB
present
protrudes into the hepatic duct through the fistula
II
Management of Type I lesions:
(1) for Type IA lesion, cholecystectomy with closure of the cystic duct
(2) for Type IB lesions, cholecystectomy and choledochoplasty with a 5 mm cuff from the gallbladder.
Management of Type II lesions (Shah et al):
(1) If the fistula is large (> 2/3 of common bile duct diameter) or the common bile duct is extensively damaged, then a Roux-en-Y anastomosis is made with the jejunum.
(2) If the fistula is from 1/3 to 2/3 of the common bile duct diameter then a choledochoplasty is performed with a 10 mm cuff from the gallbladder.
(3) If the fistula is less than 1/3 of the common bile duct diameter, then a choledochoplasty is performed with a 5 mm cuff from the gallbladder.
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