ABSTRACT
Mirizzi's syndrome was first described in 1948. PL Mirizzi described an unusual presentation of gallstones, when lodged in either the cystic duct or Hartmann's pouch causing extrinsic compression of the common hepatic duct (CHD) leading to obstructive jaundice. It comprises four components: parallel course of the cystic duct to the CHD, impaction of stones in the cystic duct or neck of the gallbladder, mechanical obstruction of the CHD by the stones or secondary inflammation and intermittent or constant jaundice and recurrent cholangitis. There has been much recent debate about the value of surveillance/screening in the diagnosis and management of hepatocellular carcinoma (HCC). Initial management decisions should be undertaken at the regional multidisciplinary team (MDT) with discussion/referral to SLTU as appropriate. The initial management is based around four questions: What type of jaundice? What is the cause? Is it acute or chronic? and Is liver failure present?.
