Background/Objectives: Mirizzi syndrome (MS) alters biliary anatomy, complicating diagnosis and treatment. We characterized diagnostic pathways in reported cases and compared Csendes type I with types II–V. Methods: PubMed and Scopus were searched through 1 July 2026, supplemented by citation searching. Reports of five or fewer patients were eligible. Patient-level diagnostic, treatment, and outcome data were summarized; groups were compared using Fisher’s exact and Mann–Whitney U tests. Results: We included 133 publications reporting 141 patients. MS was diagnosed preoperatively in 115/138 patients (83.3%). Recognition was more frequent in type I than types II–V (92.5% vs. 76.7%; p = 0.037) and among patients with conventional imaging (94.0% vs. 76.0%; p = 0.014). ERCP use and the number of modalities did not differ by diagnostic status. Compared with type I, types II–V more frequently required bile-duct exploration (37.1% vs. 17.0%), underwent open surgery (43.5% vs. 24.5%), and developed bile leak (24.1% vs. 8.5%) or treatment-related bile-duct injury (24.1% vs. 4.3%). Conclusions: Preoperative recognition was common but less frequent in fistulizing forms. Anatomical classification and conventional imaging may assist operative planning, whereas accumulating modalities showed no diagnostic advantage.

Porcelain gallbladder (PGB) has historically been considered a premalignant condition, although recent evidence questions the strength of its association with gallbladder carcinoma. Objective: To describe the occurrence and characteristics of malignancy in patients with porcelain gallbladder, as well as clinical, imaging, and surgical characteristics reported in clinal cases. Methods: A systematic review of case reports and case series (≤5 patients) was conducted following PRISMA 2020 guidelines. PubMed/MEDLINE, ScienceDirect, and Redalyc from database inception through March 2026. Individual patient data were extracted including demographic characteristics, imaging findings, calcification pattern, surgical management, histopathology, and outcomes. Descriptive statistics were performed. Results: Fifty-four individual cases of porcelain gallbladder were identified. Patients were predominantly female (70.4%), with ages ranging from 6 to 98 years. Complete calcification was reported in 85.2% of cases. Histopathological confirmation was available in 45 cases (83.3%). Thirteen patients had gallbladder carcinoma associated with porcelain gallbladder, corresponding to 28.9% of those with pathological examinations. Incomplete calcification showed higher frequency of malignancy compared with complete calcification. Mortality was reported in three patients (5.6%), all with malignant disease. Conclusions: The proportion of malignancy observed in published case reports reflects a selected dataset and should not be interpreted as an estimate of population risk. These findings provide descriptive insights into clinical presentations and management patterns, supporting hypothesis generation rather than risk estimation.