Background
A rare case of Mirizzi syndrome with atypical presentation is reported.
Material and Method
An 81-year-old woman with a known history of cholelithiasis presented with epigastric discomfort and indigestion. Imaging investigations revealed Mirizzi syndrome, while a cholecystobiliary fistula at the junction of the hepatic ducts was recognized intraoperatively and treated successfully with cholecystectomy and Roux-en-Y hepaticojejunostomy. During two years' follow-up the patient remains free of biliary symptoms.
Results

Conclusions
Diagnosis of Mirizzi syndrome requires a high degree of clinical suspicion, especially in cases without obstructive jaundice. A fistula at the level of the confluence of the hepatic ducts is a rare topographic variant of the syndrome that may need a totally different surgical approach.

Keywords: Tomography, X-Ray Computed, Hepatic Duct, Common - ultrasonography, Gallstones - radiography, Fistula - ultrasonography, Cholelithiasis - ultrasonography, Cholangiopancreatography, Magnetic Resonance, Syndrome, Anastomosis, Roux-en-Y, Abnormalities, Multiple - ultrasonography