Mirizzi syndrome type II (McSherry classification) is characterized by which finding?

• A Gallstone impacted in Hartmann's pouch compressing the common hepatic duct from outside
• B Complete destruction of the CBD with cholecystocholedochal fistula involving more than two-thirds of circumference
• C Gallstone obstructing the intrahepatic left hepatic duct
• D Cholecystocholedochal fistula with a stone eroding through less than one-third of the CBD circumference ✓

Explanation

The McSherry classification of Mirizzi syndrome distinguishes: Type I (extrinsic compression of CHD by an impacted Hartmann's stone without fistula) and Types II–IV (cholecystocholedochal fistula with increasing CBD circumference involvement: type II <33%, type III 33–66%, type IV >66%). Type II specifically involves a fistula with stone erosion through less than one-third of the CBD wall, requiring partial repair with a T-tube or Roux-en-Y hepaticojejunostomy depending on the defect.

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

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