A 50-year-old woman presents with right hypochondrial pain and fever. MRCP shows a dilated CBD with a filling defect at the mid-CBD and two intrahepatic ductal stones. She has Mirizzi syndrome Type II on imaging. The defining feature of Mirizzi syndrome Type II compared to Type I is:
- A Presence of intrahepatic stones in addition to the Hartmann's pouch stone
- B Cholecystocholedochal fistula formation due to erosion of the stone into the CBD ✓
- C Biliary stricture without fistula formation
- D Complete occlusion of the common hepatic duct by external compression
Explanation
The McSherry/Csendes classification of Mirizzi syndrome distinguishes: Type I — external compression of the CHD/CBD by a stone impacted in the cystic duct or Hartmann's pouch (no fistula). Type II — cholecystocholedochal fistula where the stone has eroded through the wall of the cystic duct/gallbladder into the CBD, with <1/3 CBD wall involvement. Types III and IV involve increasing degrees of CBD wall erosion (1/3 to 2/3 and >2/3 respectively). The presence of fistula formation defines Type II and significantly alters surgical management (requires reconstruction of the CBD defect).
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.