Role of Intraoperative Near-Infrared Indocyanine Green Fluorescence Cholangiography in the Management of Acute Gangrenous Cholecystitis Secondary to Empyema of the Gallbladder in Mirizzi's Syndrome

Mirizzi syndrome, although rare, is a potential complication of long-standing gallstone disease, particularly cholecystolithiasis. Due to the nonspecific nature of its symptoms, this condition often remains undiagnosed prior to surgery in most cases. While minimally invasive approaches are generally safe in expert hands, they can be challenging and entail the risk of bile duct injuries, often necessitating conversion to bail-out procedures. Delayed management of Mirizzi syndrome can lead to serious consequences, such as empyema of the gallbladder (GB), gangrene of the GB wall, perforation, and sepsis. Intraoperative indocyanine green fluorescence imaging during laparoscopic cholecystectomy can help delineate the biliary anatomy and prevent biliary tract injuries in difficult GBs like Mirizzi syndrome.