Biliary fistula, gallstone ileus, and Mirizzi syndrome

Abstract

Abstract Biliary fistula, gallstone ileus, and Mirizzi syndrome are clinical scenarios related to a prolonged history of gallstone disease. Preoperative diagnosis is crucial for correct treatment and is still challenging. Computed tomography scan and magnetic resonance cholangiopancreatography have high diagnostic sensitivity, specificity, and accuracy. Biliary fistula is an abnormal communication between the gall bladder and another organ. The most common is a cholecystoduodenal fistula. Gallstone ileus is a mechanical bowel obstruction due to an impacted gallstone. This is a high morbidity and mortality scenario. The main therapeutic objective is to release the obstruction. Surgical enterolithotomy is the most frequently used procedure. Two-stage and one-stage surgery have selective indications. The laparoscopic approach is increasing its applicability in these complex cases and is safe and effective when performed by experienced surgeons. The endoscopic approach has selective indications in some gastroduodenal and colonic obstructions. Mirizzi syndrome is a fistula between the gall bladder and the main biliary duct. It has four different types and each one has an adequate technique for treatment. The laparoscopic approach is preferable when feasible and performed by surgeons with expertise in complex biliary surgery.