A rare case of Mirizzi syndrome type I complicated by acute cholangitis and gallbladder perforation: A diagnostic and surgical challenge

Mirizzi syndrome (MS) is an uncommon complication of cholelithiasis involving gallstone impaction in the cystic duct or gallbladder neck, leading to compression of the common hepatic duct and potential biliary obstruction. We report a case of a middle aged male who presented with acute cholangitis.Imaging revealed two large gallstones: one at the gallbladder neck causing biliary compression, and another obstructing the common bile duct. The patient was diagnosed with Mirizzi Syndrome Type I complicated by cholangitis. Despite initial clinical improvement following antibiotic therapy, the patient rapidly deteriorated, developing gallbladder perforation. Urgent laparoscopic cholecystectomy was performed with a successful outcome. This case illustrates the diagnostic challenges associated with MS, especially when complicated by acute cholangitis and gallbladder perforation. It emphasizes the need for high clinical suspicion, early imaging with modalities such as CT and MRCP, and timely surgical intervention. The successful use of a minimally invasive approach in this high-risk scenario supports its viability even in complex biliary disease. To our knowledge, this is the first reported instance of gallbladder perforation complicating MS type I with concurrent cholangitis, highlighting an aggressive presentation of this rare syndrome.