The curious case of biliary emesis and bowel obstruction from Bouveret syndrome

Chow, Bing Lun; Zia, Khawaja; Scott, Stephen K.; Pathmarajah, Mariasoosai

doi:10.1136/bcr-2019-230194

Cited by 5 publications

(5 citation statements)

References 17 publications

(37 reference statements)

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“…Three cases did not specify whether surgery was via a laparoscopic or open approach [ 18 , 27 , 29 ]. Complications (categorized according to the Clavien Dindo Classification; Supplementary Table 3 ) were reported in 29.5% (13/44) of surgical cases [ 6 , 8 , 18 , 22 , 41 , 43 , 44 , 46 , 47 , 50 , 59 , 61 ], including one post-operative fatality [ 61 ]. Three of the five most serious complications (Clavien Dindo Classification 4a, 4b, or 5) occurred in patients in whom surgery was performed as second-line treatment and endoscopic therapy had failed [ 6 , 22 , 41 ].…”

Section: Resultsmentioning

confidence: 99%

Post hoc validation of a tool that accurately predicts the outcome of endoscopic therapy in Bouveret syndrome

Swift

Ong

Zhou

et al. 2021

Gastroenterology Report

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Background Bouveret syndrome is characterized by gallstone impaction in the upper gastrointestinal tract causing gastric outlet obstruction. In Bouveret syndrome, endoscopic gallstone removal can avert the need for surgery. However, in cases in which endoscopic therapy is unlikely to succeed, endoscopic attempts delay definitive treatment and compound patient risks. We previously developed a model that predicts endoscopic outcomes from data derived through a systematic review. This tool uses gallstone length, site of impaction, and the number of planned methods of lithotripsy to predict the likelihood of endoscopic success with an accuracy of 81.0%. This study aimed to evaluate our tool performance in an independent, non-training data set and assess endoscopic and surgical outcomes. Methods Systematic searches of the PubMed, Scopus, and Cochrane databases were performed for articles published between 16 April 2018 and 1 June 2021. The data reported after our previous study were harvested and inputted into the tool to evaluate their ability to accurately predict outcomes when compared with actual outcomes. Results Newly collated data in fields of interest showed no significant statistical differences compared with previous training data sets. Endoscopic therapy was successful in 41.9% of cases. Gallstones of ≤4 cm had a higher chance of successful endoscopic intervention (odds ratio 6.7, 95% confidence interval 1.7–25.8, P < 0.01). Complications of surgery were reported in 29.5%; there was one fatality reported. Post hoc evaluation of our predictive tool demonstrated an AUROC score of 0.80. Conclusions We have demonstrated in an independent data set that the tool can be used to accurately predict outcomes of endoscopic therapy. Patients in whom endoscopic therapy is most likely to fail should be offered an early surgical opinion.

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Section: Resultsmentioning

confidence: 99%

Post hoc validation of a tool that accurately predicts the outcome of endoscopic therapy in Bouveret syndrome

Swift

Ong

Zhou

et al. 2021

Gastroenterology Report

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“…Therapeutic endoscopy is an option for patients with colonic gallstone ileus or Bouveret syndrome, but it is technically challenging and unsuccessful in up to 91% of cases. Surgery is typically required [ 17 , 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Gallstone Ileus Caused by Migration of Gallstone Through Cholecystoduodenal Fistula Resulting in Small Bowel Obstruction

Chauhan¹,

Zackria²,

Trad³

et al. 2023

Cureus

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Gallstone ileus is a rare condition characterized by mechanical obstruction of the intestine due to gallstone impaction. Diagnosis is based on clinical history, symptoms, and characteristic Computed Tomography (CT) scan findings. Treatment typically involves surgical extraction of gallstones, with laparoscopy as an effective and potentially safer approach. Here, we describe a case of an 84-year-old woman with gallstone ileus presenting with small bowel obstruction.

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“…Endoscopic removal of gallstones in the intestine has been previously described and demonstrated reasonable outcomes in high-risk patients. Unfortunately, this approach is technically challenging, requires specialized resources, and often limited to smaller gallstones (less than 3 cm) [ 11 ]. Up to 91% of endoscopic and percutaneous attempts to extract the stones are unsuccessful, requiring surgery eventually [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Gallstone Ileus: Bouveret Syndrome Presenting with Concurrent Gallstone Coleus

Park

Balasooriya

Ncube

2020

Case Reports in Surgery

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Background. Bouveret syndrome and gallstone coleus are two rare subsets of gallstone ileus. Bouveret syndrome involves a gastric outlet obstruction, whereas gallstone coleus involves an obstruction of the large intestine. Both of the conditions are caused by gallstones, which migrated from the gallbladder via the fistulae. Due to its rarity, only few cases were reported for each condition. The current case describes an even rarer case of Bouveret syndrome and gallstone coleus presenting together. The case report will hopefully provide better understanding of the disease presentation and hence, lead to early diagnosis and management. Case. Ms. B is an 86-year-old woman of Italian background who presented to our emergency department with worsening symptoms of bowel obstruction. Her past clinical history included Kaposi sarcoma, hypertension, osteoarthritis, and vitamin D deficiency with surgical history including caesarean section and tonsillectomy. On her imaging, she had two large gallstones, one in the proximal duodenum and one in the distal colon. It also showed gastric dilatation and gas in the gall bladder. She was subsequently diagnosed with Bouveret syndrome with concurrent gallstone coleus. The laparotomy revealed two points of gallstone obstruction at the first part of the duodenum and at the distal sigmoid colon. Her postoperative recovery was uncomplicated. She was discharged to the care of her family and followed up in the general surgery clinic. Conclusion. The current case report describes a unique presentation of Bouveret syndrome where an additional gallstone was found simultaneously in the sigmoid colon causing the obstruction. By introducing this novel case of having two different subsets of gallstone ileus simultaneously, there will be a better understanding of both conditions and hopefully improve our scope of practice.

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The curious case of biliary emesis and bowel obstruction from Bouveret syndrome

Cited by 5 publications

References 17 publications

Post hoc validation of a tool that accurately predicts the outcome of endoscopic therapy in Bouveret syndrome

Post hoc validation of a tool that accurately predicts the outcome of endoscopic therapy in Bouveret syndrome

Gallstone Ileus Caused by Migration of Gallstone Through Cholecystoduodenal Fistula Resulting in Small Bowel Obstruction

A Rare Case of Gallstone Ileus: Bouveret Syndrome Presenting with Concurrent Gallstone Coleus

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