Mirizzi syndrome.

Mirizzi syndrome is an uncommon complication of gallstone disease, yet highly relevant clinically in spite of the low incidence. Its importance lies in the disproportionate risk it poses during cholecystectomy, particularly through its association with bile duct injury, vascular complications, and unexpected operative difficulty1–3. For surgeons in training, Mirizzi syndrome is often not recognized before surgery. Many patients undergo cholecystectomy based solely on ultrasonographic evidence of gallstones, and the diagnosis is therefore frequently established intraoperatively4. This mismatch between expectation and operative reality underpins the risk associated with Mirizzi syndrome. Distorted anatomy, loss of familiar landmarks, and pressure to complete a standard laparoscopic cholecystectomy can combine to create circumstances in which bile duct injury occurs2,4. In this context, Mirizzi syndrome is best viewed not simply as a diagnostic entity but as a high-risk operative scenario requiring heightened situational awareness and adaptive decision-making. Mirizzi syndrome arises from prolonged inflammation caused by an impacted gallstone in the cystic duct or gallbladder neck1,5. Repeated inflammatory episodes result in fibrosis and scarring within the hepatocystic triangle, leading to distortion of anatomical planes6. The gallbladder infundibulum may become adherent to the common hepatic duct. Inflammatory distortion may also involve the right hepatic artery itself or its branches, which can be displaced into the operative field6,7. This creates a hazardous situation in which both biliary and vascular structures are vulnerable to injury. In addition to external compression, chronic pressure from an impacted stone may erode into the bile duct, producing a cholecystobiliary fistula and more advanced forms of Mirizzi syndrome8–9. Another important consideration is the recognized association between Mirizzi syndrome and gallbladder carcinoma. Chronic inflammation and longstanding gallstone disease are thought to contribute to an increased risk of malignancy in this setting7.