More than Meets the Eye: Subtle but Important CT Findings in Bouveret's Syndrome

Abstract

Better assessment of stone size, and therefore higher accuracy of diagnosis, could be achieved if attention is paid to more subtle but nonetheless important signs. These include compressed air in dependent areas of the duodenal lumen, an area of soft-tissue rather than fluid density surrounding the calcified rim of the stone, and a faint radiolucency in or beyond this soft-tissue area that could represent laminations of fat or air in the stone.

Laparoscopic management of Bouveret syndrome

“…It is worth noting that the size of the offending gallstone is often underestimated if only the calcified portion is measured5; indeed, this patient's 6 cm diameter gallstone had a CT diameter of only 2.1 cm. While ultrasound may be partly diagnostic especially in slim patients, CT is the most useful easily obtainable investigation for establishing the location of the stone, the anatomy of the fistula and the integrity of the gallbladder.…”

Diagnosis and treatment of Gallstone ileus with Cholangitis and Cholecystoenteric fistula in an Elderly Female

“…The interpretation of subtle signs on CT scanning requires skill but can increase the accuracy of the diagnosis. (14) Computed tomography (CT) scanning has been reported to offer prompt and rapid pre-operative diagnosis of gallstone ileus with sensitivity of 93%. (15) …”

Comparative analysis of MDCT and MRI in diagnosing chronic gallstone perforation and ileus

“…3), and to identify GSP and differentiate it from other acute abdomen diseases. And some CT findings in bouveret's syndrome, such as crescents of intraluminal compressed dependent air, faint radiolucency outside a calcific rim, would help to identify the true size of ectopic stone and estimate the severity of duodenal or gastric outlet obstruction precisely [15,16]. Additionally, MDCT examination was a short-time scanning and little affected by breath movement, the lying position was also easily accepted by older patients with acute abdomen.…”