What is Mirizzi Syndrome?

How Mirizzi Syndrome Mimics Serious Liver Conditions

Mirizzi Syndrome (also known as extrinsic bile compression syndrome) is a rare medical complication of gallstones where multiple impacted gallstones or a single large impacted gallstone in the cystic duct causes compression and blockage of the common bile duct or common hepatic duct. These compressions can result in jaundice and inflammation and potentially an abnormal connection (fistula) between the gallbladder and bile duct. Gallstones consists of cholesterol (75%) or pigment (bilirubin) stones. Mirizzi Syndrome is symptomatic (jaundice, pain, fever), sometimes the gallstones can block your bile duct, which performs a passage from the gallbladder to the liver. Mirizzi syndrome is known for causing this blockage in an unusual way. Here, the question can arise, like, 'How common is Mirizzi syndrome?’ so the answer is, 'It appears in too rare conditions, as it shares symptoms with other common conditions.' It can lead to complications like:

• Cholestasis:Bile accumulation in the liver results in inflammation.
• Fistula: An abnormal connection between the gallbladder and bile duct.
• Jaundice:Your skin colour turns yellowish and the whites of your eyes due to high concentration of bilirubin due to the obstructed bile flow.
• Malabsorption: Bile can’t flow into the small intestine, and it declines the ability to break proteins and certain nutrient absorption.
• Cholangitis:Bacterial infection in the liver leading to serious infection.

How is Mirizzi Syndrome diagnosed?

Diagnosis of Mirizzi syndrome can be challenging, as it may mimic other medical conditions like gallbladder cancer or bile duct cancer. Healthcare professionals investigate through a variety of tests in order to diagnose gallstone disease. Initially, they would prefer to do a physical examination by pressing on the belly to feel the swelling signs. They will also analyse the patient’s symptoms and medical history. In case patients have signs of infections and jaundice, healthcare providers will go for blood tests under Complete Blood Count (CBC) and liver function tests. In addition, doctors may need to run some imaging tests which might be under:

• Abdominal Ultrasound
• Endoscopic Retrograde Cholangiopancreatography (ERCP)
• Computed Tomography Scan (CT scan)
• HIDA Scan
• Magnetic Resonance Imaging (MRI)
• Percutaneous Trans Hepatic Cholangiogram (PTHC)

The above mentioned tests are frequently used to identify the gallstones as well as the stent of bile duct involvement.

What are the treatment options for Mirizzi Syndrome?

Primary treatment for Mirizzi Syndrome is surgery based on the stages and types of the syndrome. Further, the options include cholecystectomy (gallbladder removal), endoscopic procedures like ERCP for stone removal or stent placement and bile duct repair or reconstruction.

Detailed insights of various treatment options are given below:

1. Surgery Procedures:

• Cholecystectomy: In some rare cases, removal of the gallbladder is essential, especially in the case where it is the source of inflammation and blockage.
• Laparoscopic vs. Open Surgery: Laparoscopic surgery can be an option; however, in complex medical cases, an open surgery (laparotomy) may be preferred in order to ensure proper visualisation and to keep away from bile duct injury.
• Bile Duct Reconstruction: Based on the level of damage to the bile duct, surgical reconstruction may be needed with techniques like hepaticojejunostomy.

2. Endoscopic Intervention

• Endoscopic Retrograde Cholangiopancreatography (ERCP): This medical procedure can be preferred to remove the gallstones from the bile duct, alleviate the blockage and place the stents to keep the duct open.
• Cholangioscopy: In some medical cases, cholangioscopy can be used along with techniques such as electro hydraulic or ‘laser lithotripsy’ to break up or remove the stones.

3. Other medical consideration

• Antibiotics: Antibiotics can be used to prevent the infection, especially in cases of inflammation of bile ducts (cholangitis).
• Stent Placement: In cases of narrowing or strictures, stents can be used to keep the bile duct open, either on a temporary basis or as a long-term solution.
• T-tube Placement: In some medical cases, a T-tube is used to be placed in the bile duct to help to drain bile or facilitate post-surgery healing.

What is the difference between Mirizzi and Bouveret syndrome?

Mirizzi and Bouveret syndromes come under the complications of gallstones, but they can be differentiated at the level of their location and their resulting symptoms. Mirizzi syndrome is mainly a biliary problem, whereas Bouveret Syndrome is considered a gastrointestinal problem that causes gastric outlet obstruction. Further, in Mirizzi syndrome, a gallstone blocks the bile duct, resulting in jaundice, while in Bouveret syndrome, a gallstone causes gastric outlet blockage due to a fistula.

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