Surgical implications of stone impaction in the gall-bladder neck with compression of the common hepatic duct (Mirizzi's syndrome).

Four surgically proven cases of Mirizzi's syndrome are reported and the literature reviewed. The clinical presentation and radiological investigations are described and discussed. All four patients presented with right upper quadrant pain and progressive jaundice. Three patients reported intermittent chills and fever. The percutaneous transhepatic cholangiographic appearances in three cases were diagnostic of this condition. The diagnosis was not made in the fourth case. The important role of the cholangiographer in entertaining the diagnosis and alerting the surgeon to a difficult cholecystectomy is emphasised.