Clinical Scenario
Mirizzi Syndrome Type I — Gallstone Trapped in the Neck or Infundibulum Compressing the Common Hepatic Duct
This protocol addresses Mirizzi syndrome in its earliest anatomical form: a gallstone impacted in the neck, infundibulum, or cystic duct of the gallbladder that exerts external pressure on the common hepatic duct — without fistula formation between the gallbladder and the bile duct.
The Specific Situation
In Mirizzi type I, the obstructing stone has not eroded into adjacent ductal structures. The compression is purely external, making this the most surgically straightforward variant — yet the proximity to critical biliary anatomy demands careful operative planning.
Surgical Approach — Partial Overview
Management centres on cholecystectomy — complete removal of the gallbladder — which may be carried out by open or laparoscopic technique. A specific operative sequence is recommended to navigate the distorted anatomy safely.
The full step-by-step approach, technique selection criteria, and intraoperative considerations are in the complete protocol →
References
DOI: 10.5772/intechopen.1010159
- Mirizzi type I (11% of cases): A gallstone trapped in the neck, infundibulum, or cystic duct of the gallbladder causes compression externally to the common hepatic duct without fistula formation.
- In type I Mirizzi syndrome cases, removal of the gallbladder completely is usually feasible, and it may also be possible for types II and III Mirizzi syndrome, based on the severity of inflammation and anatomical distortions in Calot's triangle.
- An alternative approach, i.e., the fundus-first approach, is recommended, where the dissection begins at the gallbladder's fundus and moves toward Hartmann's pouch.
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