Mirizzi syndrome occurs when a large gallstone impacts in the Hartmann's pouch or cystic duct, causing extrinsic compression of the common hepatic duct. Which classification system is used and what does Type II/III involve?

• A Csendes classification; Type II = cholecystocholedochal fistula involving <1/3 of the bile duct circumference; Type III = fistula involving up to 2/3 circumference ✓
• B McSherry classification; Type II = internal biliary fistula involving <1/3 of the bile duct circumference
• C Bismuth classification; Type II = hilar stricture with right/left hepatic ducts still in communication
• D Tokyo classification; Type II = moderate severity with organ dysfunction

Explanation

Mirizzi syndrome is classified by the Csendes classification (1989): Type I — extrinsic compression only; Type II — cholecystocholedochal fistula with fistula involving <1/3 of the common hepatic duct circumference; Type III — fistula involving up to 2/3 circumference; Type IV — complete destruction of the duct wall; Type V — any type with a cholecystoenteric fistula. Types II–IV carry operative risk of bile duct injury and may require biliary reconstruction. The Bismuth classification applies to benign bile duct strictures.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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