Perioperative Nursing care of gallstone patients with Mirizzi Syndrome

Abstract

Mirizzi syndrome is a rare complication of chronic gallstone disease in which common hepatic duct is externally compressed and it can cause serious health problem.  Its pathophysiology includes the obstruction of the common hepatic duct by an impacted gallstone in the infundibulum or base of the gallbladder.  Later, recurrent inflammatory processes around the impacted gallstone cause necrotic pressure ulcer of the gallbladder wall and evolved cholecystobiliary fisstula.  Five types of the syndrome were classified based on the extent of involved cholecystobiliary fistula and associated cholecystoenteric fistula.  Each type of the syndrome determined particular surgical treatment.  Patients with Mirizzi syndrome frequently present with obstructive jaundice, right upper abdominal pain, and fever which share the common clinical characteristics with other biliary diseases.  This unspecific form of presentation leads to the difficulty of diagnosis and stage classification. The patients who have no definite diagnosis prior to surgery might loss the opportunity to have thoughtful surgical planning and are at risk of accidental bile duct injury, one of the serious intraoperative complications.  Nurses take the important roles in facilitating the accurate diagnoses by screening and appointing the patients to discuss plans of treatments with surgeons.  After surgical plannings, nurses then prepare the patients to be physically and mentally prompted to have operations.  Proper nursing cares to facilitate early recovery post operations are also crucial.  Discharge planning with necessary health educations set the patients to be ready to self-care at homes and at the time of follow up visits.  Therefore, the knowledge associated with Mirrizzi syndrome is crucial for nurses in order to deliver qualified nursing cares for the patients.