Mirizzi's syndrome pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Pathophysiology

• Mirizzi’s syndrome is caused by gallstone impaction in the cystic duct or neck of gallbladder resulting in chronic inflammation that leads to the compression, necrosis and fibrosis of common bile duct.
• This can result in fistula formation into the adjacent structures like common hepatic duct or common bile duct.
• The obstruction of bile duct either by direct compression from gallstone or scar formation results in obstructive jaundice.

• It can be divided into the following types:

• Type I lesions involve external compression of the common bile duct without any fistula formation.

• Type II lesions involve cholecystobiliary fistula with erosion of less than one‐third of the circumference of the bile duct.

• Type III lesions are fistula that involve up to two‐thirds of the duct circumference.

• Type IV lesions are complete destruction of the bile duct.

• Type V lesions described in 2008 by Beltran et al are any of the above 4 types plus the formation of cholecystoenteric fistula.