Mirizzi syndrome is a complication of gallstone disease. The McSherry-Csendes classification of Mirizzi syndrome distinguishes Type I from Type II based on:
- A Presence or absence of jaundice
- B Acute versus chronic cholecystitis
- C Whether the stone is impacted in the cystic duct or has eroded into the common hepatic duct ✓
- D Size of the impacted calculus (above or below 2 cm)
Correct answer: C. Whether the stone is impacted in the cystic duct or has eroded into the common hepatic duct
Explanation
Mirizzi syndrome Type I is external compression of the common hepatic duct by a stone impacted in the cystic duct or Hartmann's pouch without erosion, causing obstructive jaundice. Type II involves erosion of the stone into the CHD, creating a cholecystocholedochal fistula. The Csendes modification further subdivides based on fistula extent: Type II (<1/3 CHD circumference), Type III (>2/3), and Type IV (complete destruction of CHD). Surgical approach differs significantly: Type I may allow cholecystectomy alone, while Type II–IV require biliary reconstruction.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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Written and medically reviewed by the StethoPrep medical team.