Mirizzi syndrome

Mirizzi syndrome – stone impacted in Hartmann’s causes adherence to CBD, loss of Calot’s triangle.

• Type 1 - External compression

• Type II - <1/3 bile duct

• Type III – 1/3 – 2/3 bile duct

• Type IV >2/3 bile duct

• Type I

  • Subtotal cholecystectomy
  • Leave posterior wall where it is adherent to bile duct
  • Ligate cystic duct if identified and still patent
    • If not found, drain left in gallbladder fossa.

• Type II-IV

  • Presence of fistula due to erosion of impacted gallstone in Hartmann’s pouch.
  • CBD reconstruction with Roux-en-Y hepaticojejunostomy