A female of middle childhood age presented with obstructive jaundice and was diagnosed with Mirizzi syndrome via magnetic resonance cholangiopancreatography. She underwent laparoscopic cholecystectomy with intraoperative cholangiography, which confirmed external common hepatic ductal compression by an impacted gallstone. In the same operative event, transcystic common bile duct exploration and intraoperative endoscopic retrograde cholangiopancreatography (ERCP) with biliary stent placement were performed to achieve definitive stone clearance. This single-stage approach avoided repeat general anaesthesia and the need for delayed ERCP. The patient experienced transient postoperative fever but recovered well without further intervention. The stent was successfully removed 45 days postoperatively, with follow-up ERCP confirming resolution of biliary obstruction. This case highlights the feasibility and advantages of combining advanced endoscopic and surgical techniques to optimise management of paediatric Mirizzi syndrome in a single event. Referral to centres and surgeon familiarity with advanced surgical endoscopy is recommended for optimal care in paediatric patients with complex biliary pathology.
Siegler et al. (Sun,) studied this question.