INTRAOPERATIVE DIAGNOSIS OF MIRIZZI SYNDROME TYPE II: CASE REPORT

Abstract

Case Presentation: We report the case of a 42-year-old female patient with persistent pain in the right upper quadrant and a preoperative diagnosis of chronic calculous cholecystitis. During laparoscopic cholecystectomy, an impacted stone with a cholecystobiliary fistula was identified, consistent with type II Mirizzi syndrome. Cholecystectomy, bile duct exploration, and tubular drainage were performed. The patient progressed well and was discharged within 48 hours. Discussion: The syndrome is often diagnosed intraoperatively, as in the case presented. Although more common in older patients, it can occur in young women. Appropriate surgical management, based on lesion classification and extent, reduces the risk of complications and promotes a good outcome. Final Comments: In patients with chronic cholecystitis and persistent pain in the right upper quadrant, Mirizzi syndrome should be considered even in the absence of abnormalities on previous imaging studies. In the case described, the diagnosis of Mirizzi type II was only confirmed intraoperatively, when a cholecystobiliary fistula involving approximately one-third of the common hepatic duct was identified. Laparoscopic cholecystectomy, combined with bile duct exploration and tubular drain insertion, allowed early diet, discharge within 48 hours, and uneventful recovery, demonstrating the efficacy and safety of the minimally invasive approach in specialized centers.