Mirizzi syndrome: a new approach to an old problem

Mirizzi syndrome (MS) is a rare complication of gallstone disease in which the common hepatic duct is obstructed by a stone impacted at Hartmann’s pouch or cystic duct. McSherry and Csendes are the two commonly used systems to classify different types of MS. McSherry type I refers to the condition with external compression on common hepatic duct only, while type II results if a cholecystocholedochal fistula has formed. Csendes further expanded McSherry type II to type II, III and IV based on the extent of involvement of the bile duct circumference. Whenever there is coexisting cholecystoenteric fistula, it becomes a Csendes type V MS (1).