# Csendes — Csendes classification of Mirizzi syndrome

> Classifies Mirizzi syndrome by extrinsic bile-duct compression versus circumferential loss from a cholecystobiliary fistula, then adds cholecystoenteric fistula and gallstone ileus as a type V overlay.

**Situação:** vigente · **Órgão:** Vias biliares · **Órgão emissor:** Csendes et al. · **Versão:** 1989 + 2008 type V extension · **Ano:** 1989

## Procedência e vigência
- Família: léxico
- Tipo de lógica: flat
- Modalidade: MRI, CT, US
- Fonte primária: Csendes A, Diaz JC, Burdiles P, Maluenda F, Nava O. Mirizzi syndrome and cholecystobiliary fistula: a unifying classification (1989) — https://pubmed.ncbi.nlm.nih.gov/2597969/
- Última verificação: 2026-07-24
- Última checagem: 2026-07-24

## Lógica de decisão
Return a base type I-IV plus a Va/Vb overlay whenever type V applies. Keep preoperative suspicion separate from definitive wall-loss classification and use the result to communicate anatomy, not to order an operation.

## Categorias

| Código | Rótulo | Critérios | Conduta | Risco | Localizador | Verificado |
| --- | --- | --- | --- | --- | --- | --- |
| I | Type I, extrinsic compression without fistula | External compression of the common hepatic duct or common bile duct by an impacted gallstone at the gallbladder infundibulum, neck, or cystic duct, without a cholecystobiliary fistula or bile-duct-wall loss. | Flag distorted hilar and Calot-triangle anatomy before dissection and define the duct and stone relationship. The original series reported cholecystectomy with duct exploration or drainage as effective, but the type is a planning descriptor and does not prescribe a current operation. | Even without a duct-wall fistula, inflammation and distorted anatomy create bile-duct and vascular injury risk. Type I does not provide a calibrated complication probability and should not be inferred from upstream dilatation alone. | Csendes et al. 1989, PMID 2597969, abstract: Type I external compression; original operative discussion for Type I and increasing morbidity with lesion severity. | ✓ |
| II | Type II, cholecystobiliary fistula up to one-third wall loss | Cholecystobiliary fistula produced by gallstone erosion with a limited bile-duct-wall defect involving up to approximately one-third of the duct circumference. | Report the fistula and estimated wall fraction because a limited defect may permit repair or choledochoplasty in expert hands. The original series described absorbable suture or choledochoplasty using gallbladder remnant; current technique remains individualized. | A true duct-wall defect increases the complexity and risk of bile leak, stricture and iatrogenic duct injury compared with external compression alone. The code supplies no patient-specific event percentage. | Csendes et al. 1989, PMID 2597969, abstract: Type II fistula with less than one-third wall erosion and original repair options; Beltran et al. 2008 restatement uses one-third. | ✓ |
| III | Type III, fistula up to two-thirds wall loss | Cholecystobiliary fistula with a larger bile-duct-wall defect extending beyond the Type II range and involving up to approximately two-thirds of the duct circumference. | Communicate the large wall defect for hepatobiliary reconstruction planning. The original series advised against simple fistula suture and recommended choledochoplasty; the exact contemporary operation depends on tissue quality and anatomy. | The larger wall defect implies more difficult reconstruction and greater operative morbidity than limited erosion in the original severity trend, but Type III is not a calibrated outcome score. | Csendes et al. 1989, PMID 2597969, abstract: Type III fistula up to two-thirds of duct circumference, simple suture not indicated, choledochoplasty recommended. | ✓ |
| IV | Type IV, complete bile-duct-wall destruction | Cholecystobiliary fistula with complete circumferential destruction of the bile-duct wall, with the gallbladder and duct fused into a single inflammatory structure. | Flag complete wall loss for complex hepatobiliary reconstruction. The original series preferred a bilioenteric anastomosis, but imaging or type alone must not order a procedure or define the reconstruction. | Complete wall destruction is the most extensive I-IV biliary defect and was associated with the highest end of the original increasing morbidity and mortality trend. No individual risk percentage is encoded by the class. | Csendes et al. 1989, PMID 2597969, abstract: Type IV complete duct destruction, bilioenteric anastomosis preferred, operative morbidity and mortality increasing with lesion severity. | ✓ |
| Va | Type Va, cholecystoenteric fistula without gallstone ileus | Any underlying Csendes Type I-IV Mirizzi lesion with a coexisting cholecystoenteric fistula and no gallstone ileus. The involved organ can be duodenum, stomach, colon, or another directly fistulized viscus. | Report and plan for both components: the underlying I-IV biliary defect and the enteric fistula or involved organ. The 2008 series repaired enteric fistulas in the context of varied base-type operations; Va alone does not select a single procedure. | Va adds adjacent-organ involvement, difficult inflammatory planes and risk of enteric, biliary and vascular injury. The 2008 cohort showed complications rising with biliary severity, but Va is not a patient-specific risk percentage and remains incomplete without the base I-IV type. | Beltran, Csendes and Cruces 2008, DOI 10.1007/s00268-008-9660-3, Table 1 (Type V any base type plus cholecystoenteric fistula; Va without gallstone ileus), Results on involved organs and procedures, Tables 5-6 and Discussion. | ✓ |
| Vb | Type Vb, cholecystoenteric fistula with gallstone ileus | Any underlying Csendes Type I-IV Mirizzi lesion with a cholecystoenteric fistula and gallstone ileus, meaning mechanical bowel obstruction caused by a gallstone that entered through the fistula. | Treat bowel obstruction as an urgent separate problem while preserving the underlying biliary type. The 2008 validation supports a staged strategy in selected patients and often used enterolithotomy first, but physiology, obstruction site, fistula anatomy and specialist judgment determine timing and procedures. | Vb adds acute mechanical bowel obstruction to the biliary and enteric-fistula hazards. It is not simply one ordinal step above Va and does not encode an individual mortality, recurrence or operative-complication probability. | Beltran, Csendes and Cruces 2008, DOI 10.1007/s00268-008-9660-3, Table 1 (Vb with gallstone ileus), Results describing enterolithotomy and Discussion supporting two-stage surgery in selected gallstone-ileus patients. | ✓ |

### Citações por categoria
- **I**: Csendes A, Diaz JC, Burdiles P, Maluenda F, Nava O. Mirizzi syndrome and cholecystobiliary fistula: a unifying classification (1989) — https://pubmed.ncbi.nlm.nih.gov/2597969/ · Csendes et al. 1989, PMID 2597969, abstract: Type I external compression; original operative discussion for Type I and increasing morbidity with lesion severity.
- **II**: Csendes A, Diaz JC, Burdiles P, Maluenda F, Nava O. Mirizzi syndrome and cholecystobiliary fistula: a unifying classification (1989) — https://pubmed.ncbi.nlm.nih.gov/2597969/ · Csendes et al. 1989, PMID 2597969, abstract: Type II fistula with less than one-third wall erosion and original repair options; Beltran et al. 2008 restatement uses one-third.
- **III**: Csendes A, Diaz JC, Burdiles P, Maluenda F, Nava O. Mirizzi syndrome and cholecystobiliary fistula: a unifying classification (1989) — https://pubmed.ncbi.nlm.nih.gov/2597969/ · Csendes et al. 1989, PMID 2597969, abstract: Type III fistula up to two-thirds of duct circumference, simple suture not indicated, choledochoplasty recommended.
- **IV**: Csendes A, Diaz JC, Burdiles P, Maluenda F, Nava O. Mirizzi syndrome and cholecystobiliary fistula: a unifying classification (1989) — https://pubmed.ncbi.nlm.nih.gov/2597969/ · Csendes et al. 1989, PMID 2597969, abstract: Type IV complete duct destruction, bilioenteric anastomosis preferred, operative morbidity and mortality increasing with lesion severity.
- **Va**: Csendes A, Diaz JC, Burdiles P, Maluenda F, Nava O. Mirizzi syndrome and cholecystobiliary fistula: a unifying classification (1989) — https://pubmed.ncbi.nlm.nih.gov/2597969/ · Beltran, Csendes and Cruces 2008, DOI 10.1007/s00268-008-9660-3, Table 1 (Type V any base type plus cholecystoenteric fistula; Va without gallstone ileus), Results on involved organs and procedures, Tables 5-6 and Discussion.
- **Vb**: Csendes A, Diaz JC, Burdiles P, Maluenda F, Nava O. Mirizzi syndrome and cholecystobiliary fistula: a unifying classification (1989) — https://pubmed.ncbi.nlm.nih.gov/2597969/ · Beltran, Csendes and Cruces 2008, DOI 10.1007/s00268-008-9660-3, Table 1 (Vb with gallstone ileus), Results describing enterolithotomy and Discussion supporting two-stage surgery in selected gallstone-ileus patients.

## Referências cruzadas
- _fronteira compartilhada_ → [Bismuth-Corlette — Modified Bismuth-Corlette classification of perihilar cholangiocarcinoma](https://radcommons.laudos.ai/systems/bismuth-corlette.md) — Both describe obstruction at the biliary confluence: Mirizzi from extrinsic stone impaction and fistula, Bismuth-Corlette from hilar cholangiocarcinoma.

## Histórico de versões

| Data | Evento | Detalhe | Situação |
| --- | --- | --- | --- |
| 2008-10-01 | revised | Beltran and Csendes validated type V as any underlying I-IV Mirizzi lesion with a cholecystoenteric fistula, divided into Va without and Vb with gallstone ileus. | confirmed |
| 2008-01-01 | revised | Csendes classification extended with type V (cholecystoenteric fistula; Va and Vb) by Beltran and Csendes. | confirmed |


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