What Are Gallstones?
Gallstones are small stone-like hard deposits that are the collection of bile material that develops in the gallbladder. When the bile which is situated or present in the gallbladder gets hard, then it transforms into a stone-like substance called gallstone. If the gallstones obstruct the bile duct, then it can lead to severe complications in the pancreas, liver, or bile ducts.
What Is Mirizzi Syndrome?
Mirizzi syndrome is a rare condition that is a complication of gallstone disorder. There is an obstruction of the bile duct due to external compression from multiple or a single gallstone in Hartmann's pouch. Many people have no idea that they have gallstones, as they often cause no symptoms.
The gallbladder is a pear-shaped organ that releases and stores bile. It is situated on the upper abdomen on the right side, and its main function is to store bile. The bile is then released into the small intestine through ducts, and in Mirizzi syndrome, the duct gets obstructed. As the Mirizzi syndrome is rare, it is often undiagnosed until surgery is carried out for gallstones. Around 2.5 percent of cases get to know about this condition after the surgery.
What Causes Mirizzi Syndrome?
When one of the components of bile (cholesterol or bilirubin) is in excess amount, then gallstones form. Another factor is when the bile is not completely emptied thoroughly from the gallbladder. When the bile is stored for a long time then it concentrates and clumps together to form hard clumps of stones. When the new bile washes over these stones, they gradually grow into gallstones. These gallstones can travel and enter the central bile duct and grow larger in size, get stuck there, and cause inflammation.
How Does the Mirizzi Syndrome Affect the Body?
When the stones get stuck, then it causes inflammation, swelling, and infection of the gallbladder. When the biliary duct gets obstructed, it causes the bile to back up in the liver, leading to infections. Also, the nutrients and other proteins are not broken down normally due to the bile’s inability to flow into the small intestine.
One of the major complications caused due to Mirizzi syndrome is when both the walls (the wall that has the stone stuck and the walls that are compressed) erode. Because of this, the cells in the wall necrotize or get damaged, and cause abnormal openings or fistulas.
What Are the Symptoms of Mirizzi Syndrome?
Some of the common symptoms of Mirizzi syndrome include:
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Nausea and vomiting.
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Diarrhea.
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Pain and swelling in the abdomen.
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Jaundice (yellowing of the skin).
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Dark-colored urine.
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Fever.
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Cholangitis (inflammation of the bile ducts).
How Is Mirizzi Syndrome Diagnosed?
Firstly the patient may experience pain and swelling in the abdomen and can be informed to the doctor. Only symptoms will not help in the diagnosis of this condition, so certain tests will help to confirm the gallstone disease.
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Complete Blood Count (CBC): The white blood cell level gets elevated due to inflammation caused by gallstones. A healthcare expert will draw the blood from the vein in the arm by inserting a fine needle and stored in a test tube. The collected sample is sent to the laboratory for testing.
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Ultrasound: To get a clear image of the gallbladder, an ultrasound is done. The ultrasound uses high-sound waves to scan the gallbladder images and is transferred into the computer.
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Liver Function Test: This test checks if the gallstones travel out of the gallbladder and block the bile duct. A blood sample is collected and sent to the laboratory for further investigation. The enzyme levels are checked.
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Computed Tomography (CT) Scan: A CT scan is done to get a clear image of the abdomen. A set of X-rays are taken in high-frequency magnetic waves. The patient is asked to lie down on the table. The X-ray is moved in a circular motion to scan the different angles of the abdomen and gallbladder. The technician instructs the patient through a microphone from another room. The whole procedure takes 15 to 30 minutes to complete. An individual may feel a little anxious as the machine may produce a sound that may cause anxiety or fear so the healthcare provider may give earplugs that helps in blocking the sound.
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Magnetic Resonance Imaging (MRI) Scan: To get more clear images, an MRI is done. It uses magnetic waves to scan the images and transfer them to the computer. It also uses high magnetic waves that scan the affected site from every angle that helps in understanding the size and location of any swelling if involved.
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Endoscopic Retrograde Cholangiopancreatography (ERCP): It is a procedure in which a tube is inserted down the throat into the stomach and small intestine. The dye is injected to get dense and clear images. In general, Mirizzi syndrome is diagnosed through surgical procedure.
How Is Mirizzi Syndrome Treated?
Surgery is the main treatment option through which the gallstones are removed.
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Laparoscopic Cholecystectomy: It is a surgical procedure to remove the gallbladder. A few incisions are made on the right side of the abdomen, and the laparoscope is inserted. There is a thin tube attached to the camera at the end. The gallbladder is visualized on the computer screen, and is removed through another incision. The incisions are then closed through sutures. The surgery takes one to two hours to complete.
The surgical procedure is quite complicated if the condition is not properly understood. In case of inflammation, the duct gets swelled up, which can easily damage bile ducts.
Conclusion
Mirizzi syndrome is a rare disorder or complication of gallstones. The gallstones occur when there are excessive deposits of bile which becomes tiny stones. They can travel and transfer to different parts of the body. It may show symptoms like swelling, pain, and jaundice. It is either diagnosed while performing some other surgery or through CBC or liver function tests. The main treatment option is laparoscopic surgery. Proper rest and regular visits to the doctor are essential after the surgery to avoid any sort of complications and to maintain a healthy lifestyle.
