Mussina A, Berik D, Birzhanbekov N, Kaniyev S, Baimakhanov B. Mirizzi syndrome type Vb with cholecystogastric fistula causing gastric outlet obstruction: A case report. World J Gastrointest Surg 2026; 18(6): 118262 [DOI: 10.4240/wjgs.118262]
Corresponding Author of This Article
Dzhumabekov Berik, PhD, Department of General Surgery, Al-Farabi Kazakh National University, 71 Al-Farabi Avenue, Almaty 050040, Kazakhstan. dzhumabekov.berik@kaznu.kz
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Surgery
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case-report
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Mussina A, Berik D, Birzhanbekov N, Kaniyev S, Baimakhanov B. Mirizzi syndrome type Vb with cholecystogastric fistula causing gastric outlet obstruction: A case report. World J Gastrointest Surg 2026; 18(6): 118262 [DOI: 10.4240/wjgs.118262]
World J Gastrointest Surg. Jun 27, 2026; 18(6): 118262 Published online Jun 27, 2026. doi: 10.4240/wjgs.118262
Mirizzi syndrome type Vb with cholecystogastric fistula causing gastric outlet obstruction: A case report
Ayana Mussina, Dzhumabekov Berik, Nurzhan Birzhanbekov, Shokan Kaniyev, Bolatbek Baimakhanov
Ayana Mussina, Nurzhan Birzhanbekov, Department of General Surgery, National Scientific Center of Surgery, Kazakh National Medical University, Almaty 050004, Kazakhstan
Dzhumabekov Berik, Department of General Surgery, Al-Farabi Kazakh National University, Almaty 050040, Kazakhstan
Shokan Kaniyev, Bolatbek Baimakhanov, Department of Hepatobiliary Surgery and Liver Transplantation, National Scientific Center of Surgery, Kazakh National Medical University, Almaty 050004, Kazakhstan
Co-first authors: Ayana Mussina and Dzhumabekov Berik.
Author contributions: Mussina A designed the study, collected the clinical data, and drafted the manuscript; Berik D performed the surgical procedure and contributed to data interpretation; Mussina A and Berik D contributed equally as co-first authors; Birzhanbekov N and Kaniyev S analyzed the imaging findings and perioperative data; Baimakhanov B critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Dzhumabekov Berik, PhD, Department of General Surgery, Al-Farabi Kazakh National University, 71 Al-Farabi Avenue, Almaty 050040, Kazakhstan. dzhumabekov.berik@kaznu.kz
Received: January 8, 2026 Revised: January 24, 2026 Accepted: March 18, 2026 Published online: June 27, 2026 Processing time: 169 Days and 16.7 Hours
Abstract
BACKGROUND
Mirizzi syndrome (MS) type Vb is an exceptionally rare and advanced form of gallstone disease characterized by the presence of a cholecystoenteric fistula associated with gastrointestinal obstruction. Its presentation as gastric outlet obstruction is uncommon and poses significant diagnostic and surgical challenges.
CASE SUMMARY
We report the case of a 36-year-old woman who presented with progressive vomiting, intolerance to solid food, and significant weight loss. Preoperative investigations revealed gastric outlet obstruction and features of chronic gallstone disease; however, the exact etiology remained unclear. Intraoperatively, a cholecystogastric fistula with migrated gallstones and severe cicatricial deformation of the pyloroduodenal region was identified, consistent with MS type Vb. The patient underwent distal gastrectomy with Billroth II reconstruction, cholecystectomy, exploration of the common bile duct, and intraoperative cholangiography. The postoperative course was uneventful, with complete resolution of symptoms.
CONCLUSION
MS type Vb should be considered a rare cause of gastric outlet obstruction in patients with long-standing gallstone disease. Definitive diagnosis is often established intraoperatively, and surgical management should be individualized based on the extent of inflammatory and structural changes to achieve favorable outcomes.
Core Tip: Mirizzi syndrome (MS) type Vb is an exceptionally rare and advanced form of gallstone disease characterized by a cholecystoenteric fistula. We report a unique case of MS type Vb complicated by a cholecystogastric fistula leading to fixed gastric outlet obstruction. Unlike typical gallstone migration, obstruction in this case was caused by irreversible inflammatory and cicatricial deformation of the pyloroduodenal region. This report highlights diagnostic challenges, the limitations of preoperative imaging, and the need for individualized surgical decision-making in advanced MS.
