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Qian W, Soares J, Jayewardene ID, Peck N. Bouveret syndrome preceding classical gallstone ileus: a rare presentation of a cholecystoduodenal fistula. J Surg Case Rep 2024; 2024:rjae421. [PMID: 39036768 PMCID: PMC11260179 DOI: 10.1093/jscr/rjae421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 06/13/2024] [Indexed: 07/23/2024] Open
Abstract
Bouveret syndrome is the rarest variant of gallstone ileus characterized by the passage and impaction of a gallstone through a bilioenteric fistula leading to gastric outlet obstruction. The documented movement of an impacted gallstone in Bouveret syndrome through the gastrointestinal tract has not been previously discussed in the literature. A 64-year-old man presented with acute on chronic epigastric pain, fevers, and vomiting. Abdominal computed tomography established a diagnosis of Bouveret syndrome. A trial of endoscopic gallstone extraction was unsuccessful. Laparoscopic gastrotomy and stone removal were later attempted, however, intraoperatively it was noted that the stone had migrated and was now impacted in the jejunum causing a small bowel obstruction. The clinical picture was now that of gallstone ileus. Laparoscopic enterolithotomy was performed successfully. This article discusses the radiological, endoscopic, and intraoperative findings in this rare case of Bouveret syndrome that had evolved into classical gallstone ileus following stone migration.
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Affiliation(s)
- William Qian
- Department of General Surgery, Royal North Shore Hospital, Reserve Rd, St Leonards, NSW 2065, Australia
| | - Jewel Soares
- Faculty of Medicine & Health, The University of New South Wales, Kensington, NSW, 2052, Australia
| | - Ishanth Devinda Jayewardene
- Acute Surgical Unit, Port Macquarie Base Hospital, Wrights Rd, Port Macquarie, NSW 2444, Australia
- School of Rural Medicine, Charles Sturt University, 7 Major Innes Rd, Port Macquarie, NSW 2444, Australia
- Faculty of Medicine & Health, The University of New South Wales, Kensington, NSW 2052, Australia
| | - Nigel Peck
- Department of General Surgery, Port Macquarie Base Hospital, Wrights Rd, Port Macquarie, NSW 2444, Australia
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Ranjan P, Jha VC, Gopal P, Banerjee D. Management of complicated Bouveret's syndrome. BMJ Case Rep 2024; 17:e261232. [PMID: 38890110 DOI: 10.1136/bcr-2024-261232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
Bouveret's syndrome is an uncommon cause of gastric outlet obstruction caused by the impaction of large gallstones in the duodenal lumen. The gallstones pass into the duodenal lumen through a cholecystogastric or a cholecystoduodenal fistula. Endoscopic retrieval with or without lithotripsy is the first line of management, often with variable success. We present a case of a woman in her 70s who presented with signs of gastric outlet obstruction and was diagnosed with Bouveret's syndrome with a 5 cm diameter gallstone in the third part of her duodenum. Following several unsuccessful attempts of endoscopic extraction, she underwent successful jejunal enterotomy with fragmentation and extraction of the calculus using an Allis tissue holding forceps. Postoperative recovery was uneventful.
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Affiliation(s)
- Priya Ranjan
- Gastrointestinal Surgery, Army Hospital (Research and Referral), New Delhi, Delhi, India
| | - Vijay Chetan Jha
- Gastrointestinal Surgery, Command Hospital (Western Command), Panchkula, Haryana, India
| | - Prashant Gopal
- Medical Gastroenterology, Dr D Y Patil Medical College, Hospital and Research Center, Dr D Y Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
| | - Debabrata Banerjee
- Medical Gastroenterology, Dr D Y Patil Medical College, Hospital and Research Center, Dr D Y Patil Vidyapeeth (Deemed to be University), Pune, Maharashtra, India
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3
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Nagata K, Fujikawa T. Surgical Strategy in Bouveret's Syndrome: Report of a Case With One-Stage Surgery. Cureus 2024; 16:e56707. [PMID: 38646252 PMCID: PMC11032645 DOI: 10.7759/cureus.56707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/23/2024] Open
Abstract
Bouveret's syndrome is a rare condition caused by a gallstone that impacts the duodenum via a cholecystoduodenal fistula and obstructs the gastric outlet. Despite its high mortality rate, the treatment strategy for Bouveret's syndrome is debatable and frequently challenging. The main issue is whether cholecystectomy and fistula repair following stone extraction should be performed concurrently with one-stage surgery. We present a case of Bouveret's syndrome that was treated with one-stage surgery using a bailout procedure.
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Affiliation(s)
- Keiji Nagata
- Surgery, Kokura Memorial Hospital, Kitakyushu, JPN
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Bhandari TR, Wong JLH, Ahmad J, Akbari K, Menon V. Bouveret's syndrome: An old diagnosis. A modern multimodality approach (endoscopic and robotic surgical) of gastric outlet obstruction: Report of two cases. Int J Surg Case Rep 2024; 114:109134. [PMID: 38113565 PMCID: PMC10772237 DOI: 10.1016/j.ijscr.2023.109134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Bouveret's syndrome is an uncommon condition characterized by the impaction of a gallstone in the pylorus or duodenum via a cholecysto-enteric fistula causing gastric outlet obstruction. We report two unusual cases of Bouveret's syndrome causing gastric outlet obstruction in two elderly patients. CASE PRESENTATION Two elderly female patients presented to the surgical assessment unit with features of gastric outlet obstruction. In both cases, an urgent computed tomography (CT) of the abdomen showed pneumobilia, gastric distension, and gallstones impaction at the duodenal bulb. In Patient 1, endoscopic removal of the impacted gallstones was done successfully. She was discharged three days following an uneventful recovery. In Patient 2, an endoscopic removal of a single large gallstone was attempted, which was unsuccessful. She underwent robotic gastrotomy with extraction of the large gallstone with primary repair. She was discharged on 8th postoperative day. CLINICAL DISCUSSION Treatment options for Bouveret's syndrome include endoscopic management and surgery. The selection of treatment options depends upon factors like the degree of obstruction, the impaction site, number, type or size of gallstones, patient co-morbidities and clinical parameters at presentation, as well as expertise available, both endoscopic and surgical. CONCLUSIONS Bouveret's syndrome is one of the rare complications of gallstone. Endoscopic management can be effective at removing the impacted gallstones, which is particularly helpful for those elderly patients who have multiple medical co-morbidities, as in our first patient. Surgical management like minimal invasive surgery (robotic) can be beneficial in failed endoscopic attempt of removal of stone like in the second patient.
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Affiliation(s)
- Tika Ram Bhandari
- Department of Upper Gastrointestinal and Bariatric Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom.
| | - John Lin Hieng Wong
- Department of Gastroenterology and Endoscopy, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Jawad Ahmad
- Department of Hepatobiliary and Pancreatic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Khalid Akbari
- Department of Upper Gastrointestinal and Bariatric Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Vinod Menon
- Department of Upper Gastrointestinal and Bariatric Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom; Warwick Medical School, University of Warwick, Coventry, United Kingdom
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Bergeron E, Pichette M. Two Sites of Obstruction with Gallstones: A Case Report of Bouveret Syndrome with a Concurrent Biliary Ileus. Case Rep Surg 2023; 2023:9664165. [PMID: 37483865 PMCID: PMC10361827 DOI: 10.1155/2023/9664165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/29/2023] [Accepted: 07/08/2023] [Indexed: 07/25/2023] Open
Abstract
Bouveret syndrome is a gastric outlet obstruction, and biliary ileus is an obstruction of the small bowel, and both are caused by a gallstone that escaped the gallbladder through a bilio-enteric fistula. The concurrent occurrence of obstruction at both sites is encountered very rarely, and only two such cases associated with Bouveret syndrome were reported before. We now present a case involving a 78-year-old female with simultaneous obstruction at both the duodenum and jejunum. The literature is reviewed to evaluate the incidence of such a situation and to discuss the management of the case.
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Affiliation(s)
- Eric Bergeron
- Department of Surgery, Charles-Le Moyne Hospital, Greenfield Park, QC, Canada
| | - Maude Pichette
- Department of Surgery, Charles-Le Moyne Hospital, Greenfield Park, QC, Canada
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Prenatt Z, Chirayath S, Bahirwani J, Duarte-Chavez R. The Rolling Stone: Bouveret Syndrome Requiring Open Gastrotomy After Failing Electrohydraulic Lithotripsy. Cureus 2023; 15:e39470. [PMID: 37362459 PMCID: PMC10290421 DOI: 10.7759/cureus.39470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Bouveret syndrome (BS) is an extremely rare form of gallstone ileus where a stone travels through a biliary-enteric fistula and causes gastric outlet obstruction. A 92-year-old male presented with gastric outlet obstruction secondary to an impacted gallstone in the duodenal bulb seen on imaging. Endoscopic therapy failed twice due to the immense gallstone size, and an open gastrotomy was required to remove the stone. The procedure was successful; however, the patient, unfortunately, passed away days after the operation due to other hospital illnesses. BS should be considered in patients with advanced age and significant comorbidities presenting with gastric outlet obstruction.
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Affiliation(s)
- Zarian Prenatt
- Internal Medicine, St. Luke's University Health Network, Bethlehem, USA
| | - Subin Chirayath
- Gastroenterology, St. Luke's University Health Network, Bethlehem, USA
| | - Janak Bahirwani
- Gastroenterology, St. Luke's University Health Network, Bethlehem, USA
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Gaikwad V, Subramanian M, Lim KT, Peh WCG. Clinics in diagnostic imaging (216). Singapore Med J 2023; 64:330-334. [PMID: 37203130 DOI: 10.4103/singaporemedj.smj-2021-266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Affiliation(s)
- Vishal Gaikwad
- Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
| | | | - Kheng Tian Lim
- Department of Surgery, Khoo Teck Puat Hospital, Singapore
| | - Wilfred C G Peh
- Department of Diagnostic Radiology, Khoo Teck Puat Hospital, Singapore
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Jaroenlapnopparat A, Demirjian AN, Brugge WR, Kher KR. A Case of Bouveret's Syndrome Treated With Holmium:Yttrium-Aluminum-Garnet Laser. Cureus 2023; 15:e37258. [PMID: 37162779 PMCID: PMC10164363 DOI: 10.7759/cureus.37258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2023] [Indexed: 05/11/2023] Open
Abstract
Bouveret's syndrome is a rare form of gallstone ileus described as a gastric outlet obstruction from a gallstone that travels from the gallbladder to the bowel through a bilioenteric fistula. Despite its rarity, the mortality rate of this condition is high. Endoscopic treatment is preferred over surgery due to the association with lower mortality rate. To date, there are limited data about the application of holmium:yttrium-aluminum-garnet (YAG) laser lithotripsy for fragmentation of gallstones in Bouveret's syndrome. We present the case of a 74-year-old man with multiple cardiac comorbidities who presented with periumbilical pain, decreased appetite, and vomiting. The patient had previously been admitted three months prior with acute cholecystitis, and a cholecystostomy tube was placed. He had leukocytosis and purulent discharge in his cholecystostomy bag. Computed tomography (CT) scan of the abdomen and pelvis showed a change in the position of a previously seen large gallstone from the neck of the gallbladder on the last admission, to the lumen of the duodenal bulb on this admission. This indicated the development of a cholecystoduodenal fistula, with the stone passing through this fistula into the duodenal bulb, causing the complete obstruction. Endoscopic treatment was recommended by the surgery team due to cardiac comorbidities and the significant friability of the tissue requiring laparotomy. Initial endoscopic evaluation showed complete obstruction of the duodenal bulb by a large smooth stone, not allowing passage of a guidewire beyond the stone. Therefore, holmium:YAG laser lithotripsy was used. After two sessions of laser therapy, four days apart, each breaking a pigmented and calcified stone, it eventually passed through the small bowel into the colon, relieving the obstruction. The patient had a favorable outcome and did not require surgery. This case report shows that holmium:YAG laser lithotripsy is capable of delivering favorable outcomes, as seen in a patient with a heavily calcified and pigmented stone, older age, and multiple comorbidities. Holmium:YAG laser could be considered for use with endoscopic equipment for future management of this condition, especially in patients who have medical comorbidities and heavily calcified gallstones.
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Affiliation(s)
| | - Aram N Demirjian
- Surgery, Mount Auburn Hospital, Harvard Medical School, Cambridge, USA
| | - William R Brugge
- Gastroenterology, Mount Auburn Hospital, Harvard Medical School, Cambridge, USA
| | - Kinnari R Kher
- Gastroenterology, Mount Auburn Hospital, Harvard Medical School, Cambridge, USA
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Shaheen J, Al Laham O, Ibrahim Basha Z, Atia F, Sharaf Aldeen R, Isaac M, Alhanwt A. Bouveret Syndrome simultaneous with an incidental solitary Gastric Neuroendocrine Tumor in a 44-year-old female - A Case Report. Ann Med Surg (Lond) 2023; 85:1206-1212. [PMID: 37113963 PMCID: PMC10129185 DOI: 10.1097/ms9.0000000000000459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 03/16/2023] [Indexed: 04/29/2023] Open
Abstract
Bouveret Syndrome (BS) is a rare type of gallstone ileus, where a gallstone passes via a cholecystoduodenal fistula and causes gastric outlet obstruction. It comprises 0.3-0.5% of cholelithiasis complications. It primarily affects females with an average incidence age of 74 years. Gastric Neuroendocrine Tumors (G-NETs) make up merely 2% of all forms of gastric neoplasia and are known to be an extremely rare occurrence. Their annual incidence is estimated to be one to two per 1 million individuals, and they comprise 8.7% of all known neuroendocrine neoplasia of the gastrointestinal system. Case presentation We present the case of a 44-year-old Middle Eastern female who presented to the clinic due to multiple episodes of food containing biliary nonprojectile emesis accompanied by epigastric pain. Preoperative radiological workup revealed a Bezoar blocking the gastric outlet and a G-NET in the mucosal layer of the stomach. Clinical discussion Surgical intervention consisted of excising the impacted calculus to relieve the existing gastric outlet obstruction simultaneous to performing an uncut Roux-en-Y to treat the G-NET condition. The patient underwent complete recovery. Conclusion BS is an extremely rare form of gallstone ileus and gastric outlet obstruction. Its clinical presentation is nonspecific and results in misdiagnosis. Additionally, it is rare to occur in our patient's age group. NETs are also profoundly rare forms of neoplasia. To the best of our knowledge, no previous cases of simultaneous BS and G-NET have been documented. Therefore, clinical awareness should be raised to timely implement the necessary therapeutic interventions.
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Affiliation(s)
- Jack Shaheen
- Department of Surgery, Al Assad University Hospital
- Department of Surgery, Faculty of Medicine
| | - Omar Al Laham
- Department of Surgery, Faculty of Medicine
- Corresponding author. Address: Department of Surgery, Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic. E-mail address: (O. Al Laham)
| | - Zein Ibrahim Basha
- Department of Pathology, Al Assad University Hospital
- Department of Pathology, Faculty of Medicine, Damascus University, Damascus, (The) Syrian Arab Republic
| | - Fareed Atia
- Department of Surgery, Al Assad University Hospital
- Department of Surgery, Faculty of Medicine
| | - Rahaf Sharaf Aldeen
- Department of Surgery, Al Assad University Hospital
- Department of Surgery, Al-Mouwasat University Hospital
- Department of Surgery, Faculty of Medicine
| | | | - Alaa Alhanwt
- Department of Surgery, Al Assad University Hospital
- Department of Surgery, Faculty of Medicine
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Sanyang N, Shanti H, Patel AG. Successful endoscopic management of Bouveret syndrome. J Surg Case Rep 2022; 2022:rjac484. [PMID: 36329780 PMCID: PMC9621700 DOI: 10.1093/jscr/rjac484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 09/27/2022] [Indexed: 01/24/2023] Open
Abstract
We present a frail 83-year-old female with Bouveret syndrome managed using an endoscopic approach. Our patient attended the emergency department with abdominal pain, vomiting and signs of sepsis. She had a recent admission with acute cholecystitis that which had been managed conservatively. Axial imaging revealed aerobilia with a 14 mm common bile duct and a 3.5 cm calculus impacted in the duodenum, in association with a cholecysto-duodenal fistula. After resuscitation, an oesphagoduodenoscopy was performed under general anaesthesia. The large stone was seen impacted in the first part of duodenum. Mechanical lithotripsy and the Kudo snare were employed to fragment the stone and remove large fragments. Bouveret syndrome is rarely managed with success through endoscopy. The syndrome typically occurs in frail, elderly co-morbid patients who would benefit from endoscopic management over open surgery. Despite low success rates historically, endoscopic management is a reasonable and viable option in cases of Bouveret syndrome.
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Affiliation(s)
- Nyimasata Sanyang
- Department of General Surgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Hiba Shanti
- Department of General Surgery, King's College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Ameet G Patel
- Correspondence address. King’s College Hospital, Denmark Hill, London SE5 9RS, UK. E-mail: ; Tel: 0044 7740705060; Fax: 02032993883
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Dixon A, Williams MD, Makiewicz K, Khokar A, Bonomo S. Two unique cases of Bouveret syndrome with review of literature. J Surg Case Rep 2022; 2022:rjac379. [PMID: 36003224 PMCID: PMC9393188 DOI: 10.1093/jscr/rjac379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 07/30/2022] [Indexed: 12/01/2022] Open
Abstract
Bouveret syndrome is a rare form of gallstone ileus in which a proximally lodged gallstone in the duodenum causes a gastric outlet obstruction. It is a rare condition that can be challenging to manage. Although endoscopic management remains first line, a surgical approach can be needed. We present two cases of Bouveret syndrome. A 65-year-old man with oral squamous cell carcinoma treated with endoscopic management and a 63-year-old woman treated with surgery.
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Affiliation(s)
- Austin Dixon
- Department of Surgery, Midwestern University (Chicago College of Osteopathic Medicine) , Chicago, IL , USA
| | - Michael D Williams
- Department of General Surgery, Rush University Medical Center , Chicago, IL , USA
| | - Kristine Makiewicz
- Department of General Surgery, Cook County Health (John H. Stroger Hospital) , Chicago, IL , USA
| | - Amna Khokar
- Department of General Surgery, Cook County Health (John H. Stroger Hospital) , Chicago, IL , USA
| | - Steven Bonomo
- Department of General Surgery, Cook County Health (John H. Stroger Hospital) , Chicago, IL , USA
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Probert S, Cai W, Islam F, Ballanamada Appaiah NN, Salih A. Bouveret Syndrome: A Rare Case and Review of the Literature. Cureus 2022; 14:e24768. [PMID: 35686250 PMCID: PMC9170448 DOI: 10.7759/cureus.24768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2022] [Indexed: 11/15/2022] Open
Abstract
Bouveret syndrome is a subtype of gallstone ileus, wherein a calculus becomes entrapped in the duodenum via a cholecystocolic fistula, leading to gastric outlet obstruction. Due to the non-specific symptoms the patients present with, a diagnosis is reliant on computed tomography (CT), magnetic resonance imaging (MRI) or direct endoscopic visualisation. We report a case of Bouveret syndrome and review current literature, outlining the aetiopathogenesis and management strategies of this condition.
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Shelton J, Samad MA, Juhng J, Terry SM. Unusual Presentation of Bouveret Syndrome Resulting in Both Gastric Outlet Obstruction and Small Bowel Obstruction with Perforation. MEDICINES (BASEL, SWITZERLAND) 2022; 9:24. [PMID: 35323723 PMCID: PMC8954268 DOI: 10.3390/medicines9030024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 06/14/2023]
Abstract
Our case describes an 83-year-old female who presented with severe abdominal pain, nausea, and bilious emesis of one day's duration. She had an endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and percutaneous transhepatic biliary drainage (PTCD) one year prior for choledocholithiasis with acute cholangitis in her home country, Scotland. Unfortunately, while visiting family in the United States, her PTCD became dislodged, and she developed progressive worsening abdominal pain. Computerized tomography of her abdomen showed pneumobilia, perigastric inflammation, a contracted gallbladder, small bowl inflammation with a likely transition point at the mid-jejunum, and a probable duodenal mass. The patient underwent an exploratory laparotomy with intraoperative findings of choledochoduodenal fistula with coincident gastric and small bowel obstruction (SBO) secondary to three large, mixed gallstones. One 3 cm gallstone was located at the pylorus and two (2.3 and 3 cm) gallstones were isolated in the mid-jejunum, with one of those causing isolated transmural pressure necrosis with subsequent perforation. Bouveret syndrome is a rare cause of gastric outlet obstruction (GOO) that manifests via an acquired cholecystoenteric fistula. Our patient presented with a concomitant GOO and SBO with perforation of the mid-jejunum. Timely diagnosis of Bouveret syndrome is essential, as most causes require emergent surgical intervention.
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Varre JS, Wu JL, Hopmann P, Ruiz O, Reddy R. Endoscopic and surgical management of Bouveret's syndrome complicated by gallstone ileus. J Surg Case Rep 2021; 2021:rjab464. [PMID: 34729172 PMCID: PMC8557323 DOI: 10.1093/jscr/rjab464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/24/2021] [Indexed: 12/04/2022] Open
Abstract
Bouveret’s syndrome is a rare complication that occurs most commonly in elderly patients with multiple comorbidities. It is secondary to an impacted gallstone causing gastric outlet obstruction from a cholecystoduodenal fistula, and there is no defined standardized management in current literature. A 92-year-old woman presents to our tertiary community hospital with abdominal discomfort concerning for bowel obstruction. Computed tomography revealed pneumobilia with a cholecystoduodenal fistula and a large gallstone in the proximal duodenum causing gastric outlet obstruction. The impacted gallstone failed endoscopic extraction with electrohydraulic lithotripsy, and patient subsequently developed distal gallstone ileus requiring exploratory laparotomy and enterolithotomy. This case report examines the need for early coordinated endoscopic and surgical management of a patient with Bouveret’s syndrome complicated by gallstone ileus as it is associated with high morbidity and mortality rates.
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Affiliation(s)
- Jaya Sai Varre
- Department of General Surgery, OhioHealth Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - Jin Ling Wu
- Department of General Surgery, OhioHealth Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - Peter Hopmann
- Department of General Surgery, OhioHealth Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - Oscar Ruiz
- Department of General Surgery, OhioHealth Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA
| | - Raghuram Reddy
- Ohio Gastroenterology Group, Inc., OhioHealth Riverside Methodist Hospital, 3400 Olentangy River Road, Columbus, OH 43202, USA
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Poh WS, Wijesuriya R. Case report - Bouveret's syndrome with pancreatitis: A rare combination. Int J Surg Case Rep 2021; 81:105713. [PMID: 33684647 PMCID: PMC7941036 DOI: 10.1016/j.ijscr.2021.105713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/24/2022] Open
Abstract
High suspicion of Bouveret’s syndrome required in pancreatitis with persistent vomit. CT imaging or endoscopy are suitable tools to diagnose Bouveret’s syndrome. Endoscopy retrieval is first-line therapy as surgical mortality risk is 12–30%. 90% of cases require surgical stone retrieval if cannot be removed endoscopically. Prolonged recovery can be expected as pancreatitis complicates patient’s management.
Introduction and importance Bouveret’s syndrome is characterised by gastric outlet obstruction due to impaction of gallstone in the duodenum through a cholecystoduodenal fistula, having concurrent pancreatitis makes it an even rarer presentation. Case presentation We present an 82-year-old woman who presented with acute pancreatitis which she described 2 days of right upper quadrant pain with nausea and vomiting. Biliary obstruction signs were not present. She was known to have cholelithiasis but was for non-operative management due to significant cardiac history and multiple comorbilities. Clinical findings and investigations On initial examination, abdomen was soft with mild right upper quadrant tenderness. Murphy sign was negative. Lipase level was raised at 64,261U/L with cholestasis appearance on liver function test. Bouveret’s syndrome was later diagnosed on CT after symptoms of gastric outlet obstruction surfaced during her admission. Interventions and outcome An on-table endoscopic stone retrieval was done as first-line treatment. After multiple attempts of stone retrieval via endoscopy, surgical extraction of the impacted gallstone was required. Patient’s post-operative care was further challenged by effects from pancreatitis. Patient eventually recovered well and was discharged from hospital. Relevance and impact When managing patients with gallstone pancreatitis, presence of persistent vomiting should raise suspicion of Bouveret’s syndrome. Bouveret’s syndrome can be diagnosed in these patients with aid of CT imaging or endoscopy. Stone extraction is required to treat Bouveret’s syndrome, endoscopic retrieval is first-line therapy as surgery has mortality risk of 12–30%. Prolonged recovery period can be expected due to concurrent inflammatory effects from acute pancreatitis.
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Affiliation(s)
- Wei Shearn Poh
- General Surgery, St John of God Midland Hospital, 1 Clayton Street, Midland, 6056 Western Australia, Australia.
| | - Ruwan Wijesuriya
- General Surgery, St John of God Midland Hospital, 1 Clayton Street, Midland, 6056 Western Australia, Australia.
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Sadovnikov I, Anthony M, Mushtaq R, Khreiss M, Gavini H, Arif-Tiwari H. Role of magnetic resonance imaging in Bouveret's syndrome: A case report with review of the literature. Clin Imaging 2021; 77:43-47. [PMID: 33640790 DOI: 10.1016/j.clinimag.2021.02.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 12/15/2020] [Accepted: 02/21/2021] [Indexed: 12/22/2022]
Abstract
Bouveret's syndrome is a rare form of gallstone ileus occurring due to obstructing gallstone into the proximal duodenum through a cholecystoduodenal fistula. We report the case of a 72-year-old female presenting with abdominal pain secondary to a large gallstone in the region of the duodenal bulb, causing the upstream gastric obstruction. Here we discuss the clinical features, imaging technologies, and surgical management of Bouveret's syndrome.
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Affiliation(s)
- Irina Sadovnikov
- Department of Medical Imaging, University of Arizona, Tucson, AZ, USA.
| | | | - Raza Mushtaq
- Department of Medical Imaging, University of Arizona, Tucson, AZ, USA
| | | | - Hemanth Gavini
- Department of Medicine, University of Arizona, Tucson, AZ, USA
| | - Hina Arif-Tiwari
- Department of Medical Imaging, University of Arizona, Tucson, AZ, USA
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Taggarsi M, Lapsia SK, Raymond T, Sultana A. Bouveret's syndrome: a strategic approach for management. BMJ Case Rep 2021; 14:e238326. [PMID: 33563692 PMCID: PMC7875278 DOI: 10.1136/bcr-2020-238326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 12/25/2022] Open
Abstract
An 81-year-old woman, diabetic and hypertensive, presented with nausea and intermittent vomiting. She had dysphagia and loss of appetite for over 6 weeks and significant weight loss over 3 weeks and was admitted in general surgery unit on emergency basis. Investigations revealed dilated stomach and a stone in first part of duodenum, with probable site of obstruction at level of first part of duodenum, secondary to a cholecystoduodenal fistula. With a preoperative diagnosis of Bouveret's syndrome, she underwent laparotomy and subtotal cholecystectomy. Postoperative recovery was delayed due to gastroparesis and delayed gastric emptying which resolved with conservative management. Successful management of this case required a multidisciplinary team approach. Early diagnosis was the key to management. Mode of treatment and management of Bouveret's syndrome should be tailored to suit patient's age, comorbidities and performance status.
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Affiliation(s)
- Meghana Taggarsi
- Department of General and HPB Surgery, Royal Blackburn Hospital, Blackburn, UK
| | | | - Thomas Raymond
- Department of General Surgery, Royal Lancaster Infirmary, Lancaster, UK
| | - Asma Sultana
- Department of General and HPB Surgery, Royal Blackburn Hospital, Blackburn, UK
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18
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Vanek P, Freeman ML, Trikudanathan G. Complex endoscopic management of gallbladder cancer patient with Bouveret syndrome. VideoGIE 2021; 6:16-18. [PMID: 33490747 PMCID: PMC7805016 DOI: 10.1016/j.vgie.2020.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Petr Vanek
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota
- Second Department of Internal Medicine, Palacky University Olomouc and University Hospital Olomouc, Olomouc, Czech Republic
| | - Martin L Freeman
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota
| | - Guru Trikudanathan
- Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota, Minneapolis, Minnesota
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19
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Checkley EW, Balian V, Aziz A, Lee F. Bouveret syndrome: a clinicoradiological perspective. BMJ Case Rep 2020; 13:e238620. [PMID: 33370996 PMCID: PMC7757474 DOI: 10.1136/bcr-2020-238620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 12/24/2022] Open
Abstract
An 87-year-old woman presented to us with a 5-day history of worsening epigastric pain and vomiting. Her medical history included known gallstones and a previous episode of acute cholecystitis complicated by a perforated gallbladder for which she had declined surgery 5 years prior. Radiological imaging confirmed a large gallstone impacted in the first part of the duodenum with gross gastric outlet obstruction and pneumobilia, confirming the diagnosis of Bouveret syndrome, an often overlooked and rare variant of gallstone ileus. Following an unsuccessful oesophagogastroduodenoscopy for stone retrieval, she underwent a laparotomy and gastrotomy with a successful outcome and discharged from hospital 4 weeks following the procedure.
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Affiliation(s)
| | - Vartan Balian
- Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Abdul Aziz
- Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Fred Lee
- Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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20
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Bouveret Syndrome: A Systematic Review of Endoscopic Therapy and a Novel Predictive Tool to Aid in Management. J Clin Gastroenterol 2020; 54:758-768. [PMID: 32898384 DOI: 10.1097/mcg.0000000000001221] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND GOALS Bouveret syndrome is characterized by gastroduodenal obstruction caused by an impacted gallstone. Current literature recommends endoscopic therapy as the first line of intervention despite significantly lower success rates compared with surgery. The lack of treatment efficacy studies and the paucity of clinical guidelines contribute to current practices being arbitrary. The aim of this systematic review was to identify factors that predict outcomes of endoscopic therapy. Subsequently, a predictive tool was devised to predict the success of endoscopic therapy and recommendations were proposed to improve current management strategies of impacted gallstones in the upper gastrointestinal tract. METHODS A systematic search of PubMed, Medline, Cochrane, and Scopus was performed for articles that contained the terms "Bouveret syndrome," "Bouveret's syndrome," "gallstone" AND "gastric obstruction" and "gallstone" AND "duodenal obstruction" that were published between January 1, 1950 to April 15, 2018. Articles were reviewed by 3 reviewers and raw data collated. χ and Kolmogorov-Smirnov tests were used to test associations between predictors and endoscopic outcomes. A logistic regression model was then used to create a predictive tool which was cross validated. RESULTS Failure of endoscopic therapy is associated with increasing gallstone length (P<0.0001) and impaction in the distal duodenum (P<0.05). Using multiple endoscopic modalities is associated with better success rates (P<0.05). The novel predictive tool predicted success of endoscopic therapy with an area under the receiver operating characteristic score of 0.86 (95% confidence interval: 0.79-0.94). CONCLUSION In Bouveret syndrome, a selective approach to endoscopic therapy can expedite definitive treatment and improve current management strategies.
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21
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Evola G, Caramma S, Caruso G, Dapri G, Evola FR, Reina C, Reina GA. Bouveret's syndrome as a rare complication of cholelithiasis: Disputes in current management and report of two cases. Int J Surg Case Rep 2020; 71:315-318. [PMID: 32492642 PMCID: PMC7264957 DOI: 10.1016/j.ijscr.2020.05.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/15/2022] Open
Abstract
Bouveret’s syndrome is a rare complication of cholelithiasis that determines an unusual type of gallstone ileus. This syndrome is associated with high morbility and mortality rates. Diagnosis of Bouveret’s syndrome is difficult because of non-specific symptoms and its rarity. Here are no guidelines for the diagnostic work up and the correct management of this pathology. The endoscopic or surgical management should be tailored to the patient’s clinical presentation and morbidities.
Introduction Bouveret’s syndrome is a rare complication of cholelithiasis that determines an unusual type of gallstone ileus, secondary to an acquired fistula between the gallbladder and either the duodenum or stomach with impaction of a large gallbladder stone. Preoperative diagnosis is difficult because of its rarity and the absence of typical symptoms. Adequate treatment consists of endoscopic or surgical removal of obstructive stone. Presentation of cases Two old females patients were admitted to the Emergency Department with a history of abdominal pain associated with bilious vomiting. Physical examination revealed abdominal distension with tympanic percussion of the upper quadrants, abdominal pain on deep palpation of all quadrants and in the first patient positive Murphy’s sign. Preoperative diagnosis of gallstone impacted in the duodenum was obtained by abdominal computed tomography (CT) scan in the first patient and by esophagogastroduodenoscopy in the second one. Both patients underwent surgery with extraction of the gallstone from the stomach. Postoperative course of two patients was uneventful and they were discharged home. Discussion Bouveret’s syndrome usually presents with signs and symptoms of gastric outlet obstruction. Preoperative radiological investigations not always are useful for its diagnosis. Appropriate treatment, endoscopic or surgical, is debated and must be tailored to each patient considering medical condition, age and comorbidities. Conclusion Bouveret’s syndrome is a very rare complication of cholelithiasis, difficult to diagnose and suspect, because of lack of pathognomonic symptoms. Nowaday there are no guidelines for the correct management of this pathology. Endoscopic or surgical removal of obstructive stone represents the correct treatment.
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Affiliation(s)
- Giuseppe Evola
- General and Emergency Surgery Department, Garibaldi Hospital, Catania, Italy.
| | - Sebastiano Caramma
- General Surgery Department, San Salvatore Hospital, Paternò, Catania, Italy
| | | | - Giovanni Dapri
- Department of Gastrointestinal Surgery, Saint-Pierre University Hospital, Brussels, Belgium
| | | | - Carlo Reina
- General Surgery Department, San Salvatore Hospital, Paternò, Catania, Italy
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22
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Sazhin A, Tyagunov A, Ermakov I, Gasanov M, Tyagunov A. On the issue of standardization of the treatment of gallstone obstruction. ACTA ACUST UNITED AC 2020. [DOI: 10.17116/endoskop20202605146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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23
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Abstract
Bouveret syndrome, a rare cause of intestinal obstruction, occurs by passage of a gallstone through a cholecystoduodenal fistula into the intestinal lumen. Presenting symptoms are nausea, vomiting, and abdominal pain. In some cases, chronic symptoms result in weight loss. Typically, the syndrome is diagnosed via x-ray, ultrasound, or computed tomography. Treatment options are endoscopic or surgical. Endoscopic approaches include mechanical lithotripsy, electrohydraulic lithotripsy, stone extraction, laser lithotripsy, extracorporeal shockwave lithotripsy, and/or duodenal stenting. When stone fragments migrate distally, surgical removal becomes necessary. We describe a distinct endoscopic treatment via stone breakage, followed by pushing the fragments of the stone into the jejunum, resolving the intestinal obstruction.
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24
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Abstract
Bouveret syndrome is a very rare form of gastric outlet obstruction following the passage of a gallstone from the gallbladder to the duodenum or pylorus through a bilioenteric fistula. We present a unique case of a 78-year-old male complaining of right upper quadrant abdominal pain and who was found to have a gallstone in the proximal duodenum along with pneumobilia and cholecysto-duodenal fistula suggestive of Bouveret’s syndrome.
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Affiliation(s)
- Jobin Philipose
- Internal Medicine, Staten Island University Hospital - Northwell Health, Staten Island, USA
| | - Hafiz M Khan
- Gastroenterology and Hepatology, Staten Island University Hospital - Northwell Health, Staten Island, USA
| | - Moiz Ahmed
- Gastroenterology, Icahn School of Medicine at Elmhurst Hospital Center, Elmhurst, USA
| | - Pretty S Idiculla
- Internal Medicine, Staten Island University Hospital - Northwell Health, Staten Island, USA
| | - Sherif Andrawes
- Gastroenterology, Staten Island University Hospital - Northwell Health, Staten Island, USA
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25
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Yu YB, Song Y, Xu JB, Qi FZ. Bouveret's syndrome: A rare presentation of gastric outlet obstruction. Exp Ther Med 2019; 17:1813-1816. [PMID: 30783453 DOI: 10.3892/etm.2019.7150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/30/2018] [Indexed: 01/10/2023] Open
Abstract
Bouveret's syndrome refers to gastric outlet obstruction caused by the formation of a cholecystoduodenal fistula with subsequent migration and impaction of a large gallstone into the duodenum. A case of a 59-year-old male who presented to our institution with consistent abdominal pain and nausea is reported herein. Bouveret's syndrome was diagnosed after conducting a computed tomography scan. Surgery was performed wherein gallstone removal was followed by cholecystectomy and fistula repair associated with a pyloric bypass via gastro-jejunostomy. The patient recovered well following surgery and has remained free of symptoms for the last year.
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Affiliation(s)
- Ya-Bin Yu
- Department of Hepatobiliary Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu 223300, P.R. China
| | - Yan Song
- Department of Hepatobiliary Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu 223300, P.R. China
| | - Jian-Bo Xu
- Department of Hepatobiliary Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu 223300, P.R. China
| | - Fu-Zhen Qi
- Department of Hepatobiliary Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, Jiangsu 223300, P.R. China
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26
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Gandhi S, Jani N. Rare cause of gastric outlet obstruction. J Community Hosp Intern Med Perspect 2018; 8:84-86. [PMID: 29686795 PMCID: PMC5906763 DOI: 10.1080/20009666.2018.1452517] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 03/08/2018] [Indexed: 02/08/2023] Open
Abstract
Bouveret’s syndrome is a rare cause of gastric outlet obstruction. The stones enter the small bowel via cholecysto-enteric fistula. The most common presenting symptoms are abdominal pain, nausea and vomiting. The gold standard diagnostic test isesophagogastroduodenoscopy (EGD). Rigler’s triad on abdominal x-ray is classic. CT scan findings are pneumobilia, cholecystoduodenal fistula and a gallstone in the duodenum. We present a case of a 75-year-old female who presents with 3 week history of nausea, vomiting, and diffuse abdominal pain. Initial presentation, imaging and EGD was concerning for malignancy. She was later diagnosed to have Bouveret’s syndrome and underwent laparoscopic small bowel enterotomy with removal of gallstones
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Affiliation(s)
- Sonal Gandhi
- Department of Medicine, Greater Baltimore Medical Center, Baltimore, MD, USA
| | - Niraj Jani
- Department of Gastroenterology, Greater Baltimore Medical Center, Baltimore, MD, USA
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27
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Alibegovic E, Kurtcehajic A, Hujdurovic A, Mujagic S, Alibegovic J, Kurtcehajic D. Bouveret Syndrome or Gallstone Ileus. Am J Med 2018; 131:e175. [PMID: 29555049 DOI: 10.1016/j.amjmed.2017.10.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Ervin Alibegovic
- Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Admir Kurtcehajic
- Department of Internal Medicine, Medical Center "Plava Poliklinika", Tuzla, Bosnia and Herzegovina
| | - Ahmed Hujdurovic
- Department of Internal Medicine, Medical Center "Plava Poliklinika", Tuzla, Bosnia and Herzegovina
| | - Svjetlana Mujagic
- Department of Radiology and Nuclear Medicine, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Jasminka Alibegovic
- Primary Health Care Center and Polyclinics Dr Mustafa Sehovic, Tuzla, Bosnia and Herzegovina
| | - Dzenita Kurtcehajic
- Department of Internal Medicine, Medical Center "Plava Poliklinika", Tuzla, Bosnia and Herzegovina
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28
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Macías Jara LA, Yépez Yépez DC, Chung Villavicencio JR, Alvarado Villegas M, Rocha Galecio A. Bouveret syndrome, a rare form of gallstone ileus. Case report. CASE REPORTS 2018. [DOI: 10.15446/cr.v4n1.65771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introducción. El síndrome de Bouveret es una entidad poco frecuente de íleo biliar que provoca obstrucción gástrica debido a la presencia de un lito biliar a nivel de píloro o duodeno y secundaria a una fistula biliodigestiva. Esta enfermedad es de difícil diagnóstico y una de sus complicaciones es la hemorragia digestiva alta; su manejo es quirúrgico y se recomienda en dos tiempos, aunque se puede manejar por endoscopia alta en aquellos cálculos <2.5cm. El pronóstico es bueno, con un post-operatorio sin novedades.Presentación del caso. Paciente de 63 años con cuadro clínico de 15 días de evolución de dolor en epigástrico y vómitos biliosos incontables. Se realizaron imágenes diagnósticas donde se evidenció masa calcificada en duodeno II, por lo que la paciente fue intervenida quirúrgicamente: se progresó el cálculo a yeyuno, se realizó enterotomía y se extrajo el lito. Al quinto día fue dada de alta sin novedades.Conclusión. El síndrome de Bouveret es una entidad rara que requiere de una adecuada valoración médica y de métodos auxiliares de imágenes para un diagnóstico oportuno.
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Bruni SG, Pickup M, Thorpe D. Bouveret's syndrome-a rare form of gallstone ileus causing death: appearance on post-mortem CT and MRI. BJR Case Rep 2017; 3:20170032. [PMID: 30363264 PMCID: PMC6159204 DOI: 10.1259/bjrcr.20170032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 12/29/2022] Open
Abstract
Bouveret’s syndrome is a very rare cause of gastric outlet obstruction occurring as a complication of cholelithiasis with cholecystogastric or cholecystoenteric fistula. Without timely diagnosis and intervention Bouveret’s syndrome can be associated with a high rate of morbidity and mortality, with common causes of death including metabolic derangements, aspiration pneumonia and post-operative complications. We report the case of a 67-year-old female found dead in her home with regurgitated gastric contents filling her mouth and nasal cavity. Post-mortem CT and MRI imaging was performed and subsequently revealed a fistulous tract between the gallbladder and proximal duodenum, with impaction of a large obstructing stone in the mid-portion of the duodenum. Post-mortem imaging also revealed findings of gastric outlet obstruction, which was presumed to be a primary contributor to her cause of death.
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Affiliation(s)
| | - Michael Pickup
- Department of Laboratory Medicine and Pathology, University of Toronto, Toronto, ON, Canada.,Provincial Forensic Pathology Unit, Ontario Forensic Pathology Service, Toronto, ON, Canada
| | - Dawn Thorpe
- Provincial Forensic Pathology Unit, Ontario Forensic Pathology Service, Toronto, ON, Canada
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30
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AL-Habbal Y, Ng M, Bird D, McQuillan T, AL-Khaffaf H. Uncommon presentation of a common disease - Bouveret's syndrome: A case report and systematic literature review. World J Gastrointest Surg 2017; 9:25-36. [PMID: 28138366 PMCID: PMC5237820 DOI: 10.4240/wjgs.v9.i1.25] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/30/2016] [Accepted: 12/07/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate and summarise the current evidence surrounding management of Bouveret's syndrome (BS). METHODS A MEDLINE search was performed for the BS. The search was conducted independently by two clinicians (Yahya AL-Habbal and Matthew Ng) in April 2016. A case of BS is also described. RESULTS A total of 315 articles, published from 1967 to 2016, were found. For a clinically meaningful clinical review, articles published before 01/01/1990 and were excluded, leaving 235 unique articles to review. Twenty-seven articles were not available (neither by direct communication nor through inter-library transfer). These were also excluded. The final number of articles reviewed was 208. There were 161 case reports, 13 reviews, 23 images (radiological and clinical images), and 11 letters to editor. Female to male ratio was 1.82. Mean age was 74 years. Treatment modalities included laparotomy in the majority of cases, laparoscopic surgery, endoscopic surgery and shockwave lithotripsy. CONCLUSION There is limited evidence in the literature about the appropriate approach. We suggest an algorithm for management of BS.
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31
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Dong M, Guerron AD, Morris-Stiff G, Chalikonda S. Choleduodenal fistula with gastric outlet obstruction. BMJ Case Rep 2016; 2016:bcr-2015-211248. [PMID: 27053537 DOI: 10.1136/bcr-2015-211248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Bouveret's syndrome, cholecystoduodenal fistula with gastric outlet obstruction secondary to an impacted gallstone, is a rare but serious complication of cholelithiasis. We report the case of a 69-year-old woman who presented with epigastric pain and vomiting in whom cross-sectional imaging revealed a duodenal mass with cholecystoduodenal fistula and pneumobilia. Endoscopic evaluation identified a large gallstone obstructing the pyloric channel. She underwent laparotomy and stone extraction with pyloroplasty, had an unremarkable recovery. She was asymptomatic at 15 months follow-up.
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Affiliation(s)
- Matthew Dong
- Department of HPB Surgery, Cleveland Clinic, Cleveland, Ohio, USA
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32
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Abstract
Bouveret's syndrome is a rare cause of gastric outlet obstruction. Its diagnosis is often delayed or overlooked. It is characterized by the passage of a large gall bladder stone through a bilio-duodenal fistula, which becomes lodged in the duodenum causing duodenal obstruction. We report the case of a 70-year-old male with a history suggestive of gall bladder disease over a 1-year period. The diagnosis was confirmed by ultrasound, which showed a single large gall bladder stone and the patient was planned for elective laparoscopic cholecystectomy. One week prior to the elective surgery he presented with upper gastrointestinal bleeding for which he was admitted, diagnosed by a gastroenterologist as bleeding duodenal ulcer and treated by local epinephrine injection and blood transfusion. One week later he presented with a picture of acute gastric outlet obstruction, which proved by endoscopy to be due to a large stone impacted in the duodenum. Endoscopic management failed and the stone was managed by open surgery. The patient made a good postoperative recovery and for the last year he has remained free of symptoms.
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33
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Gaduputi V, Tariq H, Rahnemai-Azar AA, Dev A, Farkas DT. Gallstone ileus with multiple stones: Where Rigler triad meets Bouveret’s syndrome. World J Gastrointest Surg 2015; 7:394-397. [PMID: 26730285 PMCID: PMC4691720 DOI: 10.4240/wjgs.v7.i12.394] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/09/2015] [Accepted: 10/19/2015] [Indexed: 02/07/2023] Open
Abstract
A 53-year-old man with multiple medical conditions presented to the emergency department with complaints of vomiting, anorexia and diffuse colicky abdominal pain for 3 d. A computed tomography scan of the abdomen and pelvis showed radiographic findings consistent with Rigler triad seen in small proportion of patients with small bowel obstruction secondary to gallstone impaction. In addition there was a gastric outlet obstruction, consistent with Bouveret’s syndrome. The patient underwent an exploratory laparotomy and enterotomy with multiple stones extracted. The patient had an uneventful post-surgical clinical course and was discharged home.
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34
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Smith Z, Totten J, Hughes A, Strote J. Delayed diagnosis of gastric outlet obstruction from bouveret syndrome in a young woman. West J Emerg Med 2014; 16:151-3. [PMID: 25671026 PMCID: PMC4307701 DOI: 10.5811/westjem.2014.10.23049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 09/17/2014] [Accepted: 10/01/2014] [Indexed: 02/06/2023] Open
Abstract
Bouveret syndrome is a rare presentation of gastric outlet obstruction caused by a gallstone in the proximal duodenum via a bilioenteric fistula. This is an infrequent although clinically significant cause of abdominal pain, almost exclusively in the elderly. The clinical presentation is similar to that of a small bowel obstruction with abdominal pain, nausea and vomiting. Surgery or endoscopy is often required for definitive diagnosis and therapy. We describe the case of a young woman with this condition who had a delayed diagnosis in part because of her age and the rarity of the condition.
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Affiliation(s)
- Zachary Smith
- Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington
| | - Jodie Totten
- University of Washington-Seattle Campus, Division of Emergency Medicine, Seattle, Washington
| | - Adrienne Hughes
- University of Washington-Seattle Campus, Division of Emergency Medicine, Seattle, Washington
| | - Jared Strote
- University of Washington-Seattle Campus, Division of Emergency Medicine, Seattle, Washington
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35
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Brice R, Chivot C, Deguisne JB, Sabbagh C. [Hematemesis of unusual cause]. Rev Med Interne 2014; 36:365-6. [PMID: 25212968 DOI: 10.1016/j.revmed.2014.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Accepted: 07/28/2014] [Indexed: 01/04/2023]
Affiliation(s)
- R Brice
- Service de radiologie, département de radiologie digestive, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens cedex 01, France.
| | - C Chivot
- Service de radiologie, département de radiologie digestive, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens cedex 01, France
| | - J-B Deguisne
- Service de chirurgie digestive et métabolique, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens cedex 01, France
| | - C Sabbagh
- Service de chirurgie digestive et métabolique, CHU d'Amiens, place Victor-Pauchet, 80054 Amiens cedex 01, France
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36
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Keller M, Epp C, Meyenberger C, Sulz MC. Unspecific abdominal symptoms and pneumobilia: a rare case of gastrointestinal obstruction. Case Rep Gastroenterol 2014; 8:216-20. [PMID: 25076865 PMCID: PMC4105949 DOI: 10.1159/000364818] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The case of a 77-year-old woman with symptoms of gastric outlet obstruction is presented. Transabdominal ultrasonography findings were suspicious of Bouveret's syndrome. Upper endoscopy confirmed this diagnosis. Bouveret's syndrome is a rare complication of gallstone disease caused by a bilioenteric fistula leading to gastric outlet obstruction by a gallstone and should be suspected in any patient who presents with pneumobilia without recent endoscopic retrograde cholangiopancreatography or biliary surgery.
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Affiliation(s)
- Martina Keller
- Department of Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Carola Epp
- Department of Internal Medicine, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christa Meyenberger
- Department of Gastroenterology and Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Michael Christian Sulz
- Department of Gastroenterology and Hepatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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