This protocol addresses the most severe anatomical presentation of Mirizzi syndrome: type IV, in which the cholecystobiliary fistula has progressed to the point where the common bile duct wall is completely destroyed. This finding fundamentally changes the surgical decision-making compared to earlier Mirizzi types.
Mirizzi type IV accounts for approximately 4% of Mirizzi syndrome cases. The hallmark is complete destruction of the common bile duct wall by the fistula — an extent of injury that precludes simple cholecystectomy alone and requires a more complex reconstructive strategy.
Management involves a combined resective and reconstructive procedure addressing both the gallbladder and the extensively damaged bile duct — with biliary continuity restored through a specific intestinal reconstruction. The full operative steps, technical considerations, and decision points are detailed in the structured protocol.