The Mirizzi syndrome is an uncommon condition of obstructive jaundice secondary to a common hepatic duct obstruction caused by a gallstone impacted in the gallbladder's infundibulum. The differential diagnosis includes mainly gallbladder carcinoma, sclerosing colangitis and metastatic nodes . The syndrome is classified in two principal types: type I is an acute form without fistula and type II a chronic form with fistula. The preoperative diagnosis is difficult because the clinical signs, the laboratory data and the instrumental findings are not pathognomonic. Generally the diagnosis is intraoperative as in our case. A 76 year-old man with long-time cholelithiasis history, diabetes and hepatitis C was admitted in our service for jaundice and high abdominal quadrants pain. He underwent all preoperative exams without a definitive diagnosis. The operation, by "open" approach, lead to the direct and safe management of the structures of the region involved in the inflammatory process. We performed an incomplete colicystectomy; the patient were discharged in seventh postoperative day after a colangiographic control. In conclusion, we recommend to take in consideration the Mirizzi syndrome, even if rare, as a cholelithiasis complication and to approach this syndrome with extreme caution. Particularly, in accord with the literature, we dissuade from the laparoscopic approach, which doesn't often allow a definitive treatment and submit the patient to greater risk.