Breath-taking pain in the right hypodermis area, accompanied by rapid pulse and uneven respiration may indicate one of the rare, yet dangerous cholelithiasis complications- the Mirizzi Syndrome. The direct cause of this syndrome is the impairment of bile outflow from the gallbladder.
Mirizzi Syndrome Symptoms
How to recognize Mirizzi Syndrome? The symptoms are similar to cholecystitis with the occurrence of jaundice. The most noticeable and often manifested symptom is severe pain in the upper right abdominal region. Other symptoms may indicate the occurrence of the syndrome, however further diagnosis should always be based on laboratory tests and imaging methods. Mirizzy Syndrome may be manifested by below symptoms:
- Biliary colic that lasts for over five hours
- Pain in the right lower abdomen which impairs deep breathing
- Palpably noticeable gallbladder
- Accelerated pulse
- Uneven respiration
- Cholestatic jaundice
- Positive Murphy’s sign (read more here)
- Peritoneal symptoms such as abdominal pain, gas or stools retention, fever, nausea, vomiting, and weakness
You can read more about other possible cholelithiasis complications here.
Despite the “classic” symptoms occurrence, Mirizzi Syndrome should be confirmed with a series of laboratory tests and abdominal ultrasound. Blood tests analysis for the syndrome include:
- Peripheral Morphology
- CRP protein
- Liver tests (ASPAT and ALAT)
- Alkaline Phosphatase and Amylase,
- Bilirubin level
As for the ultrasound, it may show the gallbladder wall swelling as well as
inflammation and gallstones presence.
The main cause for Mirizzi Syndrome development is the accumulation of numerous and fairly large gallstones in certain gallbladder’s areas, which are: its neck, Hartmann’s pouch or a common hepatic duct joint. Inflammation, then necrosis, and scarring attribute to fistula formation. The pressure causes common bile duct tightening resulting in cholestasis and jaundice.
Stages of Mirizzi Syndrome
There are four types of Syndrome, which depend directly on fistula measurements.
- Type I – No fistula is formed
- Type II – 33% of the biliary duct width
- Type III– Up to 66% of the biliary duct width
- Type IV– More than 66% of the width of the common bile duct
Strict diet and constant irrigation are the first line actions in the case of syndrome occurrence. Pain can be reduced with diastolic and analgesics medications and additionally, antibiotics treatment with third-generation ciclosporin or ciprofloxacin may be introduced. Treatment should take about 5-7 days. If acute cholecystitis occurs, the condition indicates carrying out Laparoscopic Cholecystectomy and reconstruction of common biliary and hepatic ducts.