Gupta AK, Surendranath A. Cholecysto-biliary fistula mimicking type 1 Mirizzi syndrome: A case report. World J Clin Cases 2025; 13(28): 108437 [DOI: 10.12998/wjcc.v13.i28.108437]
Corresponding Author of This Article
Anupam K Gupta, Department of General Surgery, SSM health, 1 Good Samaritan Way, Mt Vernon, IL 62864, United States. dranupamkumargupta@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Cholecysto-biliary fistula mimicking type 1 Mirizzi syndrome: A case report
Anupam K Gupta, Anudeep Surendranath
Anupam K Gupta, Department of General Surgery, SSM Health, Mt Vernon, IL 62864, United States
Anudeep Surendranath, Department of Surgery, Good Samaritan Hospital, Mt Vernon, IL 62864, United States
Author contributions: Gupta AK and Surendranath A contributed equally to this work; Gupta AK conceived the study, performed the surgery, and prepared the initial manuscript draft; Surendranath A assisted in data collection, literature review, and manuscript revision; Both authors reviewed and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.
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).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Anupam K Gupta, Department of General Surgery, SSM health, 1 Good Samaritan Way, Mt Vernon, IL 62864, United States. dranupamkumargupta@gmail.com
Received: April 14, 2025 Revised: May 27, 2025 Accepted: July 9, 2025 Published online: October 6, 2025 Processing time: 115 Days and 7.6 Hours
Abstract
BACKGROUND
Mirizzi syndrome is a rare complication of chronic gallstone disease in which an impacted stone causes compression or erosion of the common hepatic duct. Accurate preoperative diagnosis is crucial but often challenging. We report a case that was preoperatively diagnosed as type 1 Mirizzi syndrome but was found intraoperatively to be type 4, involving a cholecysto-biliary fistula and complete erosion of the common hepatic duct.
CASE SUMMARY
A 74-year-old woman presented with right upper quadrant discomfort. Initial workup including ultrasound and magnetic resonance cholangiopancreatography suggested Mirizzi syndrome type 1 due to extrinsic compression of the common hepatic duct. Endoscopic retrograde cholangiopancreatography confirmed a large stone without evidence of fistula. The patient underwent robotic-assisted cholecystectomy, during which a 4 cm stone was found eroding into the common hepatic duct, consistent with type 4 Mirizzi syndrome. Intraoperative cholangioscopy confirmed the fistula and allowed primary repair. The patient recovered uneventfully and was discharged on postoperative day one.
CONCLUSION
Preoperative imaging may fail to identify fistula formation in Mirizzi syndrome. Intraoperative assessment remains critical for accurate diagnosis and safe surgical management.
Core Tip: This case highlights the diagnostic challenge of Mirizzi syndrome, where advanced imaging modalities including endoscopic retrograde cholangiopancreatography and cholangioscopy suggested type 1 disease, but intraoperative findings revealed a type 4 cholecysto-biliary fistula. Robotic-assisted surgery with intraoperative cholangioscopy allowed precise diagnosis and primary biliary repair. The case underscores the importance of surgical vigilance and the role of minimally invasive techniques in managing complex biliary pathology.
