Mirizzi Syndrome Type Ii With Cholecysto-Choledochal Fistula: A Case Report

Mirizzi syndrome (MS) is a rare complication of longstanding gallstone disease, characterized by extrinsic compression or fistulization of the common bile duct (CBD) by an impacted calculus in the gallbladder infundibulum or cystic duct. Type II MS, defined by a cholecysto-choledochal fistula involving less than one-third of the CBD circumference, accounts for approximately 38% of MS cases in national surgical series, while preoperative diagnosis remains challenging and is often established only intraoperatively. We report the case of a 62-year-old male patient admitted to the Hepato-Biliary-Pancreatic Surgery Department of the IMSP Republican Clinical Hospital (RCH), Chișinău, Republic of Moldova, with a 10-day history of right hypochondrial pain, jaundice, nausea and vomiting. The workup included abdominal ultrasonography (USG), endoscopic retrograde cholangiopancreatography (ERCP), laboratory investigations and intraoperative findings. USG revealed a dilated CBD (33 mm), a thickened gallbladder wall (5–7.5 mm) and perivesicular collections, whereas ERCP confirmed MS type II with a visible cholecysto-choledochal fistula, biliary stenting being performed successfully. Laboratory findings showed cholestasis, hepatocytolysis, reactive pancreatitis and electrolyte imbalances. Open cholecystectomy with repair of the 0.6 cm CBD defect on a Kehr T-tube drainage was performed, and histopathology confirmed chronic calculous cholecystitis with acute exacerbation, with an uneventful postoperative course. MS type II remains a surgical challenge that requires a multidisciplinary preoperative approach; the combination of ERCP with biliary stenting and open cholecystectomy with Kehr drainage proved safe and effective, with a favourable clinical outcome over 17 days of hospitalization. Accurate classification according to Csendes 2008 is essential for tailoring the surgical technique.