First case reported of Bouveret Syndrome associated to duodenal and biliar perforation to retroperitoneum

Abstract

We present the case of a 69 year old woman with a history of cholecystitis, who consulted for severe abdominal pain, nausea and vomiting. Abdominal CT showed duodenal obstruction caused by a gallstone, cholecystoduodenal fistula and pneumobilia, what is known as Bouveret's syndrome, a rare form of gallstone ileus. Additionally, she presented free duodenal and vesicular perforation to retroperitoneum at the same level of the cholecystoduodenal transit point. The patient underwent a difficult cholecystectomy, enterolithotomy, repair of the duodenal defect, extensive washing and drainage of the retroperitoneum. The postoperative course was uneventful except for a laparotomy infection.

Bouveret’s Syndrome: A Rare Form of Gallstone Ileus Caused by Large Renal Cysts

“…It is very rare for fistulae to form in patients with cholelithiasis, occurring in only 0.3% to 0.5% of cases overall. In the majority of cases, they are cholecystoduodenal (60%), cholecystocolic (17%), cholecystogastric (5%), or choledochoduodenal (5%) [ 8 ]. Impacted gallstones can range from 2 to 10 cm, with a median size of 4.3 cm [ 9 ].…”

Fístula colecistogástrica descoberta após semi-obstrução intestinal

“…Assim, a maioria dos diagnósticos é feito no intraoperatório (8,14) . O principal risco dessas afecções encontra-se no deslocamento do cálculo para o trato gastrointestinal e a subse-quente ocorrência de Abdome Agudo Obstrutivo por obstrução gástrica -Sìndrome de Bouveret -, impactação em íleoterminal ou em válvula ileocecal (10,15,16) . Historicamente, o tratamento e prognóstico das FCG têm evoluído positivamente.…”

Síndrome de Bouveret: presentación clínica y manejo quirúrgico

“…Esta obstrucción suele ocurrir con mayor frecuencia en el íleon terminal, abarcando entre el 50% y el 90% de los casos, seguido por el íleon proximal y el yeyuno, con una incidencia que oscila entre el 20% y el 40% de las incidencias. Con menor frecuencia el duodeno experimenta obstrucción con una incidencia aproximada del 5% de los casos (6).…”