[A patient with a possible Mirizzi's syndrome].

Background: Mirizzi's syndrome is a rare cause of jaundice. The syndrome refers to common hepatic duct obstruction or choledoch duct obstruction caused by extrinsic compression of an impacted stone in the gallbladder neck or cystic duct.

Case Description: A 42-year-old woman was referred to the emergency department with symptoms indicative of obstructive icterus. Endoscopic retrograde cholangiopancreatography (ERCP) and a CT scan revealed signs of Mirizzi's syndrome but no indications of malignancy. Laparoscopic cholecystectomy was decided upon. This procedure revealed that the obstruction was caused by a gallbladder carcinoma.

Conclusion: Of those patients suspected of having Mirizzi's syndrome, retrospectively 5-28% prove to have carcinoma of the gallbladder. Therefore in Mirizzi's syndrome before carrying out laparoscopic cholecystectomy a careful diagnostic approach is essential. This includes ERCP or MRI cholangiopancreaticography (MRCP) and a CT scan. Even after these investigations the surgeon should only perform laparoscopic surgery with caution, as it is often converted to an open procedure and because of the risk of presence of a malignancy.