Mirizzi Syndrome Type III — Cholecystobiliary Fistula Involving One-Third to Two-Thirds of the Common Bile Duct Circumference
Mirizzi syndrome type III represents a distinct and technically demanding stage of the disease in which erosion of the gallbladder creates a direct fistula with the common bile duct. This subtype is defined by the extent of ductal wall involvement and carries specific surgical implications.
Clinical scenario
The fistula involves between one-third and two-thirds of the common bile duct's circumference — the defining feature of Mirizzi type III. This degree of biliary involvement places the case beyond simple cholecystectomy and requires a reconstructive strategy.
Surgical approach
Management in this setting involves subtotal cholecystectomy followed by a reconstructive procedure addressing the fistulous defect in the common bile duct. The reconstruction makes use of native tissue already present at the surgical site.
Full procedural detail and decision algorithm available in the structured protocol →
References
DOI: 10.5772/intechopen.1010159
- Mirizzi type III (44% of cases): The fistula involves between one-third and two-thirds of the common bile duct's circumference.
- Choledochoplasty is a surgical method employed after subtotal cholecystectomy, where the remaining portion of the gallbladder or cystic duct is used to repair a cholecysto-choledochal fistula.
- This technique is generally applied for type II Mirizzi syndrome and selected cases of type III.
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