Bouveret’s syndrome—a rare form of gallstone ileus causing death: appearance on post-mortem CT and MRI

Bruni, Silvio G.; Pickup, Michael; Thorpe, Dawn

doi:10.1259/bjrcr.20170032

Cited by 10 publications

(7 citation statements)

References 23 publications

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“…After gallstone migration, its point of impact depends on the location of the fistula with the gastrointestinal tract. The most common fistula is the cholecystoduodenal fistula, in which the gallstone migrates in favor of peristalsis and impacts the ileocecal valve [7] . In case of cholecystocolonic fistula, the gallstone usually obstructs the sigmoid colon [8] .…”

Section: Discussionmentioning

confidence: 99%

Gallstone ileus associated with cholecystogastric fistula: Case report, diagnosis and surgical treatment

Rodriguez

Grossi

Siqueira

et al. 2021

International Journal of Surgery Case Reports

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Introduction Gallstone Ileus is a rare complication of cholelithiasis, associated with multiple episodes of cholecystitis, with the formation of adhesions and fistulas between the gallbladder and adjacent organs. Its diagnosis is difficult, requiring complementary imaging tests such as computed tomography or radiography. Presentation of case Female patient, with intestinal obstruction for 7 days, associated with abdominal pain and previous episodes of pain in the right hypochondrium for 3 months. Abdominal CT scan identified aerobilia, gallstone impacted in the ileocecal valve and small loop dilatation, in addition to a probable cholecystogastric fistula. Opted for exploratory laparotomy, enterolithotomy and fistula correction in one surgical time. Discussion Gallstone ileus is rare among the complications of cholelithiasis, in addition to the fact that cholecystogastric fistula is associated with gastric pylorus obstruction and not impaction on the ileocecal valve. Imaging tests are useful to complement the diagnosis, and if Rigler's triad is present, the suspicion of gallstone ileus is increased. The presence of fistula between the gallbladder and stomach presents a frequency between 0 and 13.3%. There is no gold standard treatment for gallstone ileus, but surgery options for each type of patient and severity level. Conclusion There is no definitive protocol for optimal surgical treatment for biliary ileus, but the possibility of enterolithotomy associated with cholecystectomy and fistula correction can be evaluated in selected patients.

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Section: Discussionmentioning

confidence: 99%

Gallstone ileus associated with cholecystogastric fistula: Case report, diagnosis and surgical treatment

Rodriguez

Grossi

Siqueira

et al. 2021

International Journal of Surgery Case Reports

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“…A Bouveretszindróma egy cholecystoenteralis sipolyon keresztül a belekben ékelődött epekövet jelent, mely következményes gyomorkimenet-obstrukciós szindrómát, bélelzáródást okoz. Számos tanulmány szerint a Bouveret-szindróma rizikótényezői a 2-8 cm nagyságú epekövek az epehólyagban, a női nem és a 60 év feletti életkor [14].…”

Section: Esetismertetésunclassified

“…A betegséget inkább az idősebb korosztályban figyelték meg, magas morbiditással (60%) és mortalitással (12-30%) [14]. Tekintettel ezen adatokra, valamint arra, hogy a betegség nehezen diagnosztizálható, a kórisme mihamarabbi felállítására és a sürgős műtéti beavatkozás mielőbbi elvégzésére kell törekednünk.…”

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Bouveret-szindróma

Tóth

Penyige

Al-Droubi

et al. 2021

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Összefoglaló. A Bouveret-szindróma egy bilioenteralis fistulán keresztül a vékonybélbe – az esetek 85%-ában a duodenumba – jutó nagy epekő okozta bélelzáródást jelenti. Leggyakrabban idős nők körében fordul elő. Jelen közleményünk célja e kórkép tüneteinek, diagnosztikájának és terápiás lehetőségeinek ismertetése egy esetbemutatás kapcsán. A 79 éves nőbeteg felvételi hasi panaszainak hátterében típusos gyomorkimenet-obstrukciós szindrómát okozó, a duodenumban beékelődött epekő, Bouveret-szindróma igazolódott. A diagnózist az elvégzett natív hasi röntgen és hasi ultrahangvizsgálatok már felvetették, de megerősítésére további képalkotó vizsgálatot (hasi CT) és endoszkópos beavatkozást végeztünk. Ezt követően sebészeti beavatkozás történt, melynek során a cholecystoduodenalis fistula zárása és az epekő eltávolítása után a beteg gyógyultan távozott. Közleményünkben a diagnózisfelállítás idejének fontosságáról, illetve a terápiás lehetőségekről számolunk be, valamint szeretnénk felhívni a figyelmet az epekő okozta gyomorürülési zavar ezen ritka formájára. Orv Hetil. 2021; 162(49): 1982–1986. Summary. Bouveret syndrome is a rare form of bowel obstruction resulting to the small intestine – in 85% of the cases to the duodenum – caused by a gallstone from a bilioenteral fistula. It occurs most commonly in elderly women. The aim of the present study is to describe the symptoms, diagnostic and therapeutic options of Bouveret syndrome due to our case report. The background of epigastric pain of the 79-year-old woman was the typical gastric outlet obstruction syndrome caused by Bouveret syndrome with an impacted gallstone into the duodenum. This diagnosis was suggested by abdominal X-ray and abdominal ultrasound; however, it was confirmed with abdominal computer tomography and upper gastrointestinal endoscopy. This was followed by surgical intervention to close the cholecystoduodenal fistula and remove the gallstone, finally the cured patient was discharged. In our study, we summarize the importance of timely diagnosis and therapeutic options, respectively, furthermore, draw attention to this rare form of gallstone-caused gastric outlet obstruction syndrome. Orv Hetil. 2021; 162(49): 1982–1986.

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“…Intestinal loop dilation was observed in 92.6% of cases, pneumobilia in 88.9%, ectopic gallstones in 81.5%, hydroaero levels in 37%, and bilio-digestive fistula in 14.8%. Yu et al [54,59] conducted a prospective study in which 165 patients with acute small bowel obstruction were evaluated for biliary ileus, with retrospective identification of three diagnostic criteria: (1) small bowel obstruction;…”

Section: Computed Tomographymentioning

confidence: 99%

“…In an 81-case review of Bouveret syndrome [37,43,[59][60][61][62] in which esophagogastroduodenoscopy (EGD) was performed, gastroduodenal obstruction was revealed in all, but visualization of gallstones was only possible in 56 (69%). Among these 56 cases, such gallstones were observed in the duodenal bulb in 51.8%, in the postbulbar duodenum in 28.6%, in the pylorus or in the prepilorum in 17.9%, and in one case the position was not reported.…”

Section: Esophagogastroduodenoscopymentioning

confidence: 99%

Gallstones Ileus

Petracca¹,

Zappia²,

Silvaggio³

2020

Intestinal Obstructions

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The ileus of gallstones is a rare complication of cholelithiasis which occurs in less than 1% of patients and is the cause of 1-4% of cases of obstruction of the small intestine. The pathogenesis involves the formation of a bilioenteric fistula. Abdominal computed tomography (CT) shows pneumobilia, dilated loops of small intestine, and ectopic gallstones that obstruct the intestinal lumen. In literature, enterolithotomy is the most frequently used procedure for the ileum of gallstones. Enterolithotomy plus cholecystectomy and/or fistulectomy are indicated only in selected patients. The clinical signs and symptoms depend on the site of the obstruction and usually include abdominal pain, nausea, and vomiting. The diagnostic test of choice is an abdominal CT scan.

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Bouveret’s syndrome—a rare form of gallstone ileus causing death: appearance on post-mortem CT and MRI

Cited by 10 publications

References 23 publications

Gallstone ileus associated with cholecystogastric fistula: Case report, diagnosis and surgical treatment

Gallstone ileus associated with cholecystogastric fistula: Case report, diagnosis and surgical treatment

Bouveret-szindróma

Gallstones Ileus

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