Mirizzi syndrome involves extrinsic compression of the common hepatic duct (CHD) by a stone impacted in the cystic duct or Hartmann's pouch. The McSherry (Csendes) classification defines Type II as:

• A Extrinsic compression of the CHD by an impacted stone in the cystic duct without erosion
• B A fistula involving more than two-thirds of the CHD circumference
• C A cholecystocholedochal fistula involving up to one-third of the CHD circumference ✓
• D Complete destruction of the CHD with gallbladder-CHD confluence fistula

Explanation

In the Csendes classification of Mirizzi syndrome: Type I — extrinsic compression without fistula; Type II — cholecystocholedochal fistula involving <1/3 of CHD circumference; Type III — fistula involving 1/3 to 2/3 of CHD; Type IV — complete destruction of the CHD. Type II requires cholecystectomy with fistula repair (primary closure or T-tube). Types III–IV require hepaticojejunostomy. Recognising Mirizzi syndrome preoperatively prevents inadvertent CHD injury.

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

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Written and medically reviewed by the StethoPrep medical team.