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1
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Evanson DJ, Elcic L, Uyeda JW, Zulfiqar M. Imaging of gallstones and complications. Curr Probl Diagn Radiol 2025; 54:392-403. [PMID: 39676027 DOI: 10.1067/j.cpradiol.2024.12.007] [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] [Received: 10/29/2024] [Accepted: 12/09/2024] [Indexed: 12/17/2024]
Abstract
Gallbladder pathologies caused by gallstones are commonly encountered in clinical practice, making accurate diagnosis critical for effective patient management. Radiologists play a key role in differentiating these conditions through imaging interpretation, ensuring that appropriate treatment is initiated. The imaging features of gallstone associated diseases are classified into various categories, such as inflammatory conditions, benign lesions, malignant tumors, and associated complications. A comprehensive understanding of these categories and their radiologic manifestations is essential for accurate diagnosis and management of gallbladder pathology. By integrating clinical knowledge with radiologic findings, clinicians and radiologists will be equipped with practical tools to identify and distinguish between different gallstone causing conditions.
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Affiliation(s)
- Davin J Evanson
- Drexel University College of Medicine at Tower Health, 50 Innovation Way, Wyomissing, PA, 19610, USA
| | - Lana Elcic
- Department of Radiology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Jennifer W Uyeda
- Brigham and Women's Hospital, Department of Radiology, 75 Francis Street, Boston, MA, 02115, USA
| | - Maria Zulfiqar
- Department of Radiology, Mayo Clinic Arizona, 13400 E Shea Blvd, Scottsdale, AZ, 85259, USA.
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2
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Pal NL, Panandiker SD, Katiyar G, Vernekar JA. Unusual causes of Small bowel obstruction: a review of the literature and revisited cross-sectional imaging checklist. Emerg Radiol 2024; 31:733-748. [PMID: 38926239 DOI: 10.1007/s10140-024-02256-8] [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] [Received: 05/11/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
Intestinal obstruction is a common surgical emergency with high morbidity and mortality. Patients presenting with features of small bowel obstruction need urgent evaluation to avoid complications such as bowel gangrene, perforation, or peritonitis. Imaging is necessary in most cases of suspected bowel obstruction, to take an appropriate decision, for apt patient management. Among the common causes of small bowel obstruction, adhesions, external herniae, malignancies, and Crohn's disease top the chart. Imaging helps in determining the presence of obstruction, the severity of obstruction, transition point, cause of obstruction, and associated complications such as strangulation, bowel gangrene, and peritonitis. This review is based on the cases with unusual causes of bowel obstruction encountered during our routine practice and also on the extensive literature search through the standard textbooks and electronic databases. Through this review we want our readers to have sound knowledge of the imaging characteristics of the uncommon yet important causes of bowel obstruction. We have also revisited and structured a checklist to simplify the approach while reporting a suspected case of small bowel obstruction. Imaging plays a key role in the diagnosis of small bowel obstruction and in determining the cause and associated complications. Apart from the common causes of small bowel obstruction, we should also be aware of the uncommon causes of small bowel obstruction and their imaging characteristics to make an accurate diagnosis and for apt patient management.
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Affiliation(s)
- Nilkanth L Pal
- Department of Radio-diagnosis, Goa Medical College, Bambolim, Goa, 403 202, India.
| | - Swamini D Panandiker
- Department of Radio-diagnosis, Goa Medical College, Bambolim, Goa, 403 202, India
| | - Glory Katiyar
- Department of Radio-diagnosis, Goa Medical College, Bambolim, Goa, 403 202, India
| | - Jeevan A Vernekar
- Department of Radio-diagnosis, Goa Medical College, Bambolim, Goa, 403 202, India
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3
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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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4
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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 PMCID: PMC10219125 DOI: 10.4103/singaporemedj.smj-2021-266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 01/25/2022] [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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5
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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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6
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Watanabe K, Kawai H, Sato T, Natsui M, Inoue R, Kimura M, Yoko K, Sasaki S, Watanabe M, Tsukada Y, Terai S. Endoscopic treatment of Bouveret syndrome with a combination of electrohydraulic lithotripsy and balloon expansion: A case report. DEN OPEN 2023; 3:e232. [PMID: 36998350 PMCID: PMC10043357 DOI: 10.1002/deo2.232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 03/30/2023]
Abstract
Bouveret syndrome is a rare type of ileus caused by the impaction of gallstones passing through a cholecystoenteric fistula in the duodenum. Endoscopic treatment with minimally invasive procedures is preferable for patients with this syndrome, typically for elderly individuals with a high surgical risk. Conventional endoscopic techniques often fail to remove impacted stones that are generally large and occasionally solid. We report the case of an 88‐year‐old bedridden woman with severe dementia who presented with difficulty in breathing. The patient was diagnosed with aspiration pneumonia. In addition, computed tomography showed a cholecystoduodenal fistula and a gallstone 37 mm in diameter that impacted the duodenal bulb. Bouveret syndrome was diagnosed on the basis of the computed tomography findings. The impacted stone was too large and hard to split with standard endoscopic lithotripsy using grasping forceps, mechanical lithotripter, polypectomy snare, basket catheter, and electrohydraulic lithotripsy (EHL). However, EHL with a dual‐channel therapeutic endoscope was achieved to drill a narrow hole approximately 20 mm deep into the stone, in four sessions. The stone was subsequently split by inflating the balloon, which was inserted into the hole, to 10 mm in diameter at 3 atm. All the split stones were spontaneously excreted during defecation after a few days. If the gallstone is too hard to fragment by endoscopic EHL alone, a combination of EHL and balloon expansion might be a useful alternative.
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Affiliation(s)
- Kotaro Watanabe
- Department of Internal MedicineNiigata Prefectural Shibata HospitalNiigataJapan
| | - Hirokazu Kawai
- Department of Internal MedicineNiigata Prefectural Shibata HospitalNiigataJapan
- Department of Internal MedicineNiigata Prefectural Kamo HospitalNiigataJapan
| | - Toshifumi Sato
- Department of Internal MedicineNiigata Prefectural Shibata HospitalNiigataJapan
- Department of GastroenterologySaiseikai Niigata HospitalNiigataJapan
| | - Masaaki Natsui
- Department of Internal MedicineNiigata Prefectural Shibata HospitalNiigataJapan
| | - Ryosuke Inoue
- Department of Internal MedicineNiigata Prefectural Shibata HospitalNiigataJapan
| | - Mayuki Kimura
- Department of Internal MedicineNiigata Prefectural Shibata HospitalNiigataJapan
| | - Kazumi Yoko
- Department of Internal MedicineNiigata Prefectural Shibata HospitalNiigataJapan
| | - Syun‐ya Sasaki
- Department of Internal MedicineNiigata Prefectural Shibata HospitalNiigataJapan
| | - Masashi Watanabe
- Department of Internal MedicineNiigata Prefectural Shibata HospitalNiigataJapan
| | - Yoshihisa Tsukada
- Department of Internal MedicineNiigata Prefectural Shibata HospitalNiigataJapan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental SciencesNiigata UniversityNiigataJapan
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7
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Sundaram KM, Morgan MA, Itani M, Thompson W. Imaging of benign biliary pathologies. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:106-126. [PMID: 35201397 DOI: 10.1007/s00261-022-03440-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/01/2022] [Accepted: 02/03/2022] [Indexed: 01/21/2023]
Abstract
Pathologies of the biliary tree include a wide-spectrum of benign and malignant processes. The differential for benign disease includes congenital and acquired disease with variable prognosis and management pathways. Given the ability to mimic malignancy, benign processes are difficult to diagnose by imaging. Direct cholangiography techniques with tissue sampling are the gold standards for the diagnosis of benign and malignant biliary pathologies. Non-invasive imaging with ultrasound offers a first-line diagnostic tool while MRI/MRCP offers higher specificity for identifying underlying pathology and distinguishing from malignant disease. In this review, we focus on the imaging appearance of dilatation, cystic anomalies obstruction, inflammation, ischemia, strictures, pneumobilia, and hemobilia to help construct a differential for benign processes.
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Affiliation(s)
- Karthik M Sundaram
- Department of Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, USA.
| | - Matthew A Morgan
- Department of Radiology, University of Pennsylvania Health System, 1 Silverstein, 3400 Spruce Street, Philadelphia, PA, USA
| | - Malak Itani
- Mallinkckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, USA
| | - William Thompson
- Department of Radiology, University of New Mexico, Albuquerque, USA
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8
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Smith E, Zhao S, El Boghdady M, Sabato-Ceraldi S. Bouveret syndrome: A challenging case of impacted gallstone within the fourth part of the duodenum. Int J Surg Case Rep 2022; 94:107084. [PMID: 35658279 PMCID: PMC9079233 DOI: 10.1016/j.ijscr.2022.107084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/11/2022] [Accepted: 04/11/2022] [Indexed: 10/27/2022] Open
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9
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Meena L, Sharma B, Singh RS, Chauhan U, Matthew A. Cholecysto-pyloric fistula with submucosal impaction of gall stone causing gastric outlet obstruction masquerading as a gastric mass, Bouveret Syndrome: case report. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00619-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cholecysto-enteric fistula is a rare complication of cholelithiasis and cholecystitis. Another even rarer complication is proximal impaction of gallstone(s) in gastric pylorus leading to gastric outlet obstruction, known as the Bouveret Syndrome. Only a few cases have been reported in the available literature. It can be confused with a malignant thickening at the pylorus, knowledge of this syndrome helps in arriving at the right diagnosis.
Case report
A 52-year-old female patient, who was admitted to our hospital for evaluation of recurrent vomiting and abdominal pain. She was investigated with various imaging modalities including upper gastrointestinal (GI) endoscopy, abdominal ultrasonography as well as Contrast Enhanced Computerized Tomography (CECT) scan of the abdomen. On the outside scan, it was given as a malignant thickening at the pylorus. However, current radiologists felt that imaging findings were not of a typical malignant mass, and suspicion of Bouveret syndrome was given. Intraoperative findings confirmed the diagnosis of Bouveret syndrome. The patient has not experienced any postoperative complications till now.
Conclusion
Bouveret syndrome is associated with significant morbidity and mortality. Being familiar with the imaging appearance of this condition, and differentiating it with malignant thickening can help radiologists avoid unnecessary invasive procedures in such patients. Being a benign etiology, it also helps in a better prognosis.
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10
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Sunnapwar A, Ojili V, Katre R, Shah H, Nagar A. Multimodality imaging of adult gastric emergencies: A pictorial review. Indian J Radiol Imaging 2021; 27:13-22. [PMID: 28515579 PMCID: PMC5385768 DOI: 10.4103/0971-3026.202957] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Acute gastric emergencies require urgent surgical or nonsurgical intervention because they are associated with high morbidity and mortality. Imaging plays an important role in diagnosis since the clinical symptoms are often nonspecific and radiologist may be the first one to suggest a diagnosis as the imaging findings are often characteristic. The purpose of this article is to provide a comprehensive review of multimodality imaging (plain radiograph, fluoroscopy, and computed tomography) of various life threatening gastric emergencies.
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Affiliation(s)
- Abhijit Sunnapwar
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Vijayanadh Ojili
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Rashmi Katre
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Hardik Shah
- Department of Body Imaging, University of Texas Health Science Center, San Antonio, Texas, USA
| | - Arpit Nagar
- Department of Body Imaging, Ohio State University Wexner Medical Center, Ohio, USA
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11
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Runyan B, Caparelli ML, Batey J, Allamaneni S, Perlman S. Bouveret syndrome: A series of cases that illustrates a rare complication of chronic cholelithiasis. Ann Hepatobiliary Pancreat Surg 2021; 25:139-144. [PMID: 33649267 PMCID: PMC7952670 DOI: 10.14701/ahbps.2021.25.1.139] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/20/2020] [Accepted: 07/24/2020] [Indexed: 12/28/2022] Open
Abstract
Bouveret syndrome is defined as gastric outlet obstruction secondary to the impaction of a large gallstone in the proximal gastrointestinal tract. The obstruction occurs as result of a bilio-enteric or bilio-gastric fistula. This clinical entity is a rare variant of the more commonly recognized gallstone ileus, which tends to cause small bowel obstruction of the terminal ileum. The typical presentation of Bouveret syndrome consists of nausea, vomiting and abdominal pain secondary to obstruction. Diagnosis often requires radiographic imaging with computed tomography, which typically shows pneumobilia or a cholecystoduodenal fistula. Herein is a series consisting of three cases of Bouveret syndrome involving a bilioenteric, cholecystoduodenal, and choledochoduodenal fistula, respectfully, all of which required operative management. A discussion of the current literature regarding management of this rare syndrome follows.
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Affiliation(s)
- Brianne Runyan
- Department of General Surgery, The Jewish Hospital of Cincinnati, Cincinnati, OH, USA
| | - Michael L Caparelli
- Department of General Surgery, The Jewish Hospital of Cincinnati, Cincinnati, OH, USA
| | - Jason Batey
- Department of General Surgery, The Jewish Hospital of Cincinnati, Cincinnati, OH, USA
| | - Shyam Allamaneni
- Department of General Surgery, The Jewish Hospital of Cincinnati, Cincinnati, OH, USA
| | - Steven Perlman
- Department of Radiology, The Jewish Hospital of Cincinnati, Cincinnati, OH, USA
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12
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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: 0.5] [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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13
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Parvataneni S, Khara HS, Diehl DL. Bouveret syndrome masquerading as a gastric mass-unmasked with endoscopic luminal laser lithotripsy: A case report. World J Clin Cases 2020; 8:5701-5706. [PMID: 33344563 PMCID: PMC7716301 DOI: 10.12998/wjcc.v8.i22.5701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/08/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Bouveret syndrome, also known as gallstone ileus, is a rare form of gastric outlet obstruction accounting for 1%-3% of cases. This condition is most often reported in females. The diagnosis can be challenging and is often missed due to atypical presentations, which occasionally mimic gastric outlet obstruction symptoms such as nausea, vomiting, loss of appetite and hematemesis. The symptoms vary with stone size. Larger stones are managed with a surgical approach, but this carries increased morbidity and mortality. Over the past decade, the endoscopic approach has emerged as an alternative mode of treatment, but it is generally unsuccessful in the management of larger-sized stones. A literature review revealed cases of successful endoscopic treatment requiring multiple sessions for stone sizes measuring up to about 4.5 cm. Here we present a unique case of an elderly patient with Bouveret syndrome with a 5 cm stone mimicking a gastric mass and causing gastric outlet obstruction, who was successfully managed in a single session using a complete endoscopic approach with laser lithotripsy. CASE SUMMARY An 85-year-old female patient presented with 1-month history of intermittent abdominal pain, vomiting, decreased appetite and weight loss. An abdominal computed tomography showed a 4.5 cm × 4.7 cm partially calcified mass at the gastric pylorus causing gastric outlet obstruction. Endoscopy showed an ulcerated fistulous opening and a large 5 cm impacted gallstone in the duodenal bulb. Endoscopic nets and baskets were used in an attempt to remove the stone, but this approach was unsuccessful. Given her advanced age, poor physical condition and underlying comorbidities, she was deemed to be high-risk for surgery. Thus, a minimally invasive approach using endoscopic laser lithotripsy was attempted and successfully treated the stone. Post-procedure, the patient experienced complete resolution of her symptoms with no complications and was able to tolerate her diet. She was subsequently discharged home at 48 h, with an uneventful recovery. CONCLUSION In our paper we describe Bouveret syndrome and highlight its management with a novel endoscopic approach of laser lithotripsy in addition to various other endoscopic approaches available to date and its success rates.
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Affiliation(s)
- Swetha Parvataneni
- Department of Internal Medicine, Geisinger Lewistown Hospital, Lewistown, PA 17044, United States
| | - Harshit S Khara
- Department of Gastroenterology and Hepatology, Advanced Endoscopy, Geisinger Health system, Danville, PA 17822, United States
| | - David L Diehl
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA 17822, United States
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14
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Nguyen BH, Le Quan AT, Hai PM, Quang Hung V, Thai TT. Duodenal Obstruction Due to Giant Gallstone: A Case Report. Int Med Case Rep J 2020; 13:651-656. [PMID: 33235520 PMCID: PMC7680121 DOI: 10.2147/imcrj.s278058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 10/20/2020] [Indexed: 11/23/2022] Open
Abstract
Background Duodenal obstruction due to a gallstone, also known as Bouveret’s syndrome, is one type of gallstone ileus. This is a rare complication of cholelithiasis. Among gallstone ileus cases, duodenal obstruction is alsorare. Apart from rareness, diagnosis is challenging due to unspecific clinical manifestation. Treatment options have benefits and drawbacks with each as well. Therefore, setting an appropriate option in a certain patient is an important issue. Case Report An 85-year-old woman presented clinically with a gastric outlet obstruction. Upper gastrointestinal (GI) endoscopy was attempted but endoscopic exploration was limited because of duodenum filled by fluid. Rigler’s triad was detected on abdominal enhanced CT scan: duodenal obstruction, ectopic gallstone within duodenum lumen, pneumobilia. The stone was very large (9 cm long). The diagnosis was duodenal obstruction due to giant gallstone and cholecysto-duodenum fistula. The patient was treated with a radical one-stage procedure: fistulotomy for gallstone removal, cholecystectomy, side-to-side Roux-en-Y duodenojejunostomy. There were no complications related to surgery during the follow-up period. Conclusion Surgery plays an important role in management of duodenal obstruction due to a gallstone, especially a large and impacted stone. Radical one-stage surgery is one of the feasible, safe, and efficient procedures in selected patients.
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Affiliation(s)
- Bac Hoang Nguyen
- University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Anh Tuan Le Quan
- Department of Hepatobiliary and Pancreatic Surgery, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Pham Minh Hai
- Department of Hepatobiliary and Pancreatic Surgery, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Vu Quang Hung
- Department of General Surgery, University of Medicine and Pharmacy Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Truc Thanh Thai
- University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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15
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Imaging of acute gastric emergencies: a case-based review. Clin Imaging 2020; 72:97-113. [PMID: 33221628 DOI: 10.1016/j.clinimag.2020.10.053] [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: 06/24/2020] [Revised: 09/07/2020] [Accepted: 10/20/2020] [Indexed: 11/21/2022]
Abstract
The stomach is one of the most frequently imaged organs in the body with dedicated and incidental inclusion in chest imaging modalities. Gastric emergencies often present clinically with non-specific abdominal, nausea, and vomiting. As such, imaging plays a critical role in early identification and treatment of a myriad of gastric emergencies. The goal of this paper is to showcase gastric emergencies as they appear on multimodality imaging.
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16
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Dunlop H, Goodarzi MR. Bouveret Syndrome: A Rare Case of Gallstone Ileus Further Complicated by Stone Migration. Cureus 2020; 12:e11219. [PMID: 33154859 PMCID: PMC7606263 DOI: 10.7759/cureus.11219] [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] [Accepted: 10/28/2020] [Indexed: 11/05/2022] Open
Abstract
Bouveret syndrome is a rare cause of gastric outlet obstruction due to gallstone impaction in the pylorus or proximal duodenum. This paper reports a case of Bouveret syndrome in a 66-year-old male patient in whom pre-operative investigations revealed a gallstone within the distal stomach, but spontaneous migration of the stone resulted in intraoperative difficulty requiring further surgical exploration than originally anticipated.
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Affiliation(s)
- Hannah Dunlop
- General Surgery, University Hospital Wishaw, Glasgow, GBR
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17
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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: 1.6] [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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18
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No way out: Causes of duodenal and gastric outlet obstruction. Clin Imaging 2020; 65:37-46. [DOI: 10.1016/j.clinimag.2020.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 03/26/2020] [Accepted: 04/07/2020] [Indexed: 11/17/2022]
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19
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Kudaravalli P, Saleem SA, Goodman A, Pendela VS, Arif MO. Bouveret syndrome as a rare cause of gastric outlet obstruction. Proc (Bayl Univ Med Cent) 2020; 33:235-236. [DOI: 10.1080/08998280.2019.1708841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/14/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022] Open
Affiliation(s)
- Pujitha Kudaravalli
- Department of Internal Medicine, Upstate Medical University, Syracuse, New York
| | - Sheikh A. Saleem
- Department of Gastroenterology, Upstate Medical University, Syracuse, New York
| | - Alexandra Goodman
- Department of Internal Medicine, Upstate Medical University, Syracuse, New York
| | | | - Muhammad Osman Arif
- Department of Gastroenterology, Upstate Medical University, Syracuse, New York
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20
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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: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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21
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Chow BL, Zia K, Scott S, Pathmarajah M. The curious case of biliary emesis and bowel obstruction from Bouveret syndrome. BMJ Case Rep 2019; 12:12/8/e230194. [PMID: 31466982 DOI: 10.1136/bcr-2019-230194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Bouveret syndrome is a rare complication of biliary lithiasis. This sequela is caused by the passage of the gallstone via a bilioenteric fistula, resulting in an impacted gallstone in the duodenum or stomach. The common presentation of non-specific symptoms contributes to the diagnostic uncertainty and delay, which is strongly associated with adverse outcomes. We report an uncomplicated stone extraction via open gastrotomy in an elderly man afflicted with bowel obstruction and biliary vomit secondary to Bouveret syndrome.
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Affiliation(s)
- Bing Lun Chow
- Department of General Surgery, Belford Hospital, Fort William, Highland, UK.,Anaesthetics and Critical Care, Borders General Hospital, Melrose, Scottish Borders, UK
| | - Khawaja Zia
- Department of General Surgery, Belford Hospital, Fort William, Highland, UK
| | - Stuart Scott
- Department of General Surgery, Belford Hospital, Fort William, Highland, UK
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22
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Abstract
Bouveret syndrome is caused by the impaction of a gallstone into the duodenum through a cholecystoduodenal fistula. This is typically followed by pyloric obstruction via retrograde migration of the stone, as opposed to anterograde migration, which can result in gallstone ileus. Bouveret syndrome usually presents with nausea, vomiting, and abdominal pain. Pneumobilia is seen on radiographic imaging. Herein, we describe a case of Bouveret syndrome where the diagnosis and treatment were delayed due to the initial patient desire for surgical intervention. Ultimately, duodenotomy was performed after several failed attempts of endoscopic stone extraction.
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Affiliation(s)
- Adel Hanandeh
- General Surgery, Columbia University School of Physicians and Surgeons at Harlem Hospital Center, Harlem, USA
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23
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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 PMCID: PMC6364238 DOI: 10.3892/etm.2019.7150] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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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24
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Zulfiqar M, Shetty A, Shetty V, Menias C. Computed Tomography Imaging of Non-Neoplastic and Neoplastic Benign Gastric Disease. Curr Probl Diagn Radiol 2019; 48:75-96. [DOI: 10.1067/j.cpradiol.2017.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/20/2017] [Accepted: 12/12/2017] [Indexed: 12/14/2022]
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25
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26
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Caldwell KM, Lee SJ, Leggett PL, Bajwa KS, Mehta SS, Shah SK. Bouveret syndrome: current management strategies. Clin Exp Gastroenterol 2018; 11:69-75. [PMID: 29497323 PMCID: PMC5819584 DOI: 10.2147/ceg.s132069] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Bouveret syndrome is a rare complication of cholelithiasis that usually presents with signs and symptoms of gastric outlet obstruction. Given the relative rarity of this condition, there are no standardized guidelines for the management of this condition. In this paper, we review the diagnosis and management options (endoscopic, laparoscopic, and open approaches) of patients with Bouveret syndrome, including a report of one case to illustrate some of the endoscopic and surgical principles of management.
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Affiliation(s)
- Kelly M Caldwell
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Seeyuen J Lee
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Phillip L Leggett
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Kulvinder S Bajwa
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Sheilendra S Mehta
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shinil K Shah
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.,Michael E. Debakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX, USA
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27
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Mearelli F, Casarsa C, Peretti A, Spagnol F, Gennari AG, De Manzini N, Biolo G. Out of Place: Gallstone Ileus. Am J Med 2017; 130:1385-1387. [PMID: 28919024 DOI: 10.1016/j.amjmed.2017.09.001] [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: 05/16/2017] [Revised: 09/11/2017] [Accepted: 09/11/2017] [Indexed: 01/16/2023]
Affiliation(s)
- Filippo Mearelli
- Clinica Medica ASUITs, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Chiara Casarsa
- Clinica Medica ASUITs, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Alberto Peretti
- Clinica Medica ASUITs, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Francesca Spagnol
- Clinica Medica ASUITs, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Antonio Giulio Gennari
- Department of Radiology, University of Trieste, Strada di Fiume 447, IT-34149, Trieste, Italy
| | - Nicolò De Manzini
- Division of General Surgery, Department of Medical and Surgical Sciences, Hospital of Cattinara, University of Trieste, Strada di Fiume 447, 34149, Trieste, Italy
| | - Gianni Biolo
- Clinica Medica ASUITs, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
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28
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Tindell N, Holmes K, Marotta D. Gallstone ileus of the duodenum: an unexpected presentation of Bouveret's syndrome. BMJ Case Rep 2017; 2017:bcr-2017-220324. [PMID: 28790094 DOI: 10.1136/bcr-2017-220324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
This report describes a patient who presented with a large gallstone obstructing the duodenal bulb, with the chief complaint of acute on chronic abdominal pain. Classically, this is known as Bouveret's syndrome or a gallstone ileus of the duodenum. Our patient's current health status presented a challenge, with the presence of several comorbidities, particularly a large abdominal aortic aneurism. We chose an open procedure for this reason. The stone was removed through a laparotomy, and the cholecystoduodenal fistula that the stone used to pass into the small bowel was repaired. With our patient's future medical needs in mind, only the necessary interventions were performed to regain functionality of the bowel. This came in the form of a diverting gastrojejunostomy, with a distal jejunostomy and feeding tube inserted. The patient tolerated the procedure well, only remaining intubated postoperative due to her chronic obstructive pulmonary disease (COPD). She achieved a complete recovery and transitioned home.
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Affiliation(s)
- Neil Tindell
- Medical Education, Alabama College of Osteopathic Medicine, Dothan, Alabama, USA
| | - Kayla Holmes
- Department of Surgery, Coosa Valley Medical Center, Sylacauga, Alabama, USA
| | - David Marotta
- Department of Surgery, Coosa Valley Medical Center, Sylacauga, Alabama, USA
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29
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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: 0.8] [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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Chuah PS, Curtis J, Misra N, Hikmat D, Chawla S. Pictorial review: the pearls and pitfalls of the radiological manifestations of gallstone ileus. Abdom Radiol (NY) 2017; 42:1169-1175. [PMID: 27896385 DOI: 10.1007/s00261-016-0996-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We present a pictorial review of a range of typical and atypical cases of gallstone ileus (GI), across a wide range of imaging modalities. GI is a complication of gallstone disease causing mechanical intestinal obstruction due to impaction of gallstone in the gastrointestinal tract. The spectrum of presentation can vary enormously, and we highlight the importance of accurate imaging diagnosis of GI especially early use of computed tomography. This will lead to timely and appropriate surgical intervention with the potential avoidance of unnecessary outcomes. The ambition of pictorial synopsis is to make the radiologists to be more vigilant to the common and more obscure imaging findings of GI.
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Affiliation(s)
- Phei Shan Chuah
- Department of Radiology, Aintree University Hospital NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, UK.
| | - John Curtis
- Department of Radiology, Aintree University Hospital NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, UK
| | - Nikhil Misra
- Department of Surgery, Aintree University Hospital NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, UK
| | - Dina Hikmat
- Department of Radiology, Aintree University Hospital NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, UK
| | - Sumita Chawla
- Department of Radiology, Aintree University Hospital NHS Foundation Trust, Lower Lane, Liverpool, L9 7AL, UK.
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31
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Abstract
Gastro-duodenal obstruction encompasses a spectrum of benign and malignant disease. Historically, chronic peptic ulcer disease was the main cause of gastro-duodenal obstruction, whereas now malignant cause with gastric carcinomas for gastric obstruction and pancreatic tumors for duodenal obstruction predominate. This paper reviews the role of CT in diagnosing gastro-duodenal obstruction, its level, its cause by identifying intraluminal, parietal, or extrinsic process, and the presence of complication.
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32
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Nuño-Guzmán CM, Marín-Contreras ME, Figueroa-Sánchez M, Corona JL. Gallstone ileus, clinical presentation, diagnostic and treatment approach. World J Gastrointest Surg 2016; 8:65-76. [PMID: 26843914 PMCID: PMC4724589 DOI: 10.4240/wjgs.v8.i1.65] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Revised: 10/28/2015] [Accepted: 12/08/2015] [Indexed: 02/07/2023] Open
Abstract
Gallstone ileus is a mechanical intestinal obstruction due to gallstone impaction within the gastrointestinal tract. Less than 1% of cases of intestinal obstruction are derived from this etiology. The symptoms and signs of gallstone ileus are mostly nonspecific. This entity has been observed with a higher frequency among the elderly, the majority of which have concomitant medical illness. Cardiovascular, pulmonary, and metabolic diseases should be considered as they may affect the prognosis. Surgical relief of gastrointestinal obstruction remains the mainstay of operative treatment. The current surgical procedures are: (1) simple enterolithotomy; (2) enterolithotomy, cholecystectomy and fistula closure (one-stage procedure); and (3) enterolithotomy with cholecystectomy performed later (two-stage procedure). Bowel resection is necessary in certain cases after enterolithotomy is performed. Large prospective laparoscopic and endoscopic trials are expected.
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33
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Guniganti P, Bradenham CH, Raptis C, Menias CO, Mellnick VM. CT of Gastric Emergencies. Radiographics 2015; 35:1909-21. [DOI: 10.1148/rg.2015150062] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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34
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Negi RS, Chandra M, Kapur R. Bouveret syndrome: Primary demonstration of cholecystoduodenal fistula on MR and MRCP study. Indian J Radiol Imaging 2015; 25:31-4. [PMID: 25709163 PMCID: PMC4329685 DOI: 10.4103/0971-3026.150136] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Bouveret syndrome is an unusual complication of cholelithiasis which results in upper gastrointestinal obstruction due to a gallstone impacted in the duodenum through a bilio-enteric fistula. We present this rare entity which was primarily diagnosed on magnetic resonance (MR) and MR cholangiopancreaticography (MRCP) study.
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Affiliation(s)
- Rajkumar Singh Negi
- Department of Radiodiagnosis, Base Hospital, Delhi Cantonment, New Delhi, India
| | - Mukesh Chandra
- Department of Radiodiagnosis, Base Hospital, Delhi Cantonment, New Delhi, India
| | - Rajiv Kapur
- Department of Radiodiagnosis, Base Hospital, Delhi Cantonment, New Delhi, India
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35
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Smolilo D, Bhandari M, Wilson TG, Brooke-Smith M, Watson DI. Bouveret's syndrome: gastric outlet obstruction caused by a gallstone. ANZ J Surg 2013; 83:996-997. [PMID: 24289055 DOI: 10.1111/ans.12227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- David Smolilo
- Flinders University Department of Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
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36
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Nickel F, Müller-Eschner MM, Chu J, von Tengg-Kobligk H, Müller-Stich BP. Bouveret's syndrome: presentation of two cases with review of the literature and development of a surgical treatment strategy. BMC Surg 2013; 13:33. [PMID: 24006869 PMCID: PMC3766223 DOI: 10.1186/1471-2482-13-33] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 08/30/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Bouveret's syndrome causes gastric outlet obstruction when a gallstone is impacted in the duodenum or stomach via a bilioenteric fistula. It is a rare condition that causes significant morbidity and mortality and often occurs in the elderly with significant comorbidities. Individual diagnostic and treatment strategies are required for optimal management and outcome. The purpose of this paper is to develop a surgical strategy for optimized individual treatment of Bouveret's syndrome based on the available literature and motivated by our own experience. CASE PRESENTATION Two cases of Bouveret's syndrome are presented with individual management and restrictive surgical approaches tailored to the condition of the patients and intraoperative findings. CONCLUSIONS Improved diagnostics and restrictive individual surgical approaches have shown to lower the mortality rates of Bouveret's syndrome. For optimized outcome of the individual patient: The medical and perioperative management and time of surgery are tailored to the condition of the patient. CT-scan is most often required to secure the diagnosis. The surgical approach includes enterolithotomy alone or in combination with simultaneous or subsequent cholecystectomy and fistula repair. Lower overall morbidity and mortality are in favor of restrictive surgical approaches. The surgical strategy is adapted to the intraoperative findings and to the risk for secondary complications vs. the age and comorbidities of the patient.
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Affiliation(s)
- Felix Nickel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Matthias M Müller-Eschner
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - Jackson Chu
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Hendrik von Tengg-Kobligk
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany
- Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Beat P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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37
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Shah SK, Walker PA, Fischer UM, Karanjawala BE, Khan SA. Bouveret syndrome. J Gastrointest Surg 2013; 17:1720-1. [PMID: 23775095 DOI: 10.1007/s11605-013-2244-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 05/31/2013] [Indexed: 01/31/2023]
Abstract
Gastric outlet obstruction secondary to an impacted duodenal gallstone, or Bouveret syndrome, is a rare variant of gallstone ileus. It is most common in elderly women and frequently requires endoscopic or surgical management. We present the case of an 80-year-old woman with multiple medical comorbidities who presented to our service with 2 weeks of abdominal pain and nausea. MRI revealed a 4.4-cm gallstone impacted in the duodenum with associated cholecystoduodenal fistula. She required operative exploration to remove the impacted stone and had an unremarkable post-operative course. This case demonstrates the presentation and workup of this rare disorder and the various options for treatment, which can sometimes be difficult given the typical age and associated comorbidities of the patient.
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Affiliation(s)
- Shinil K Shah
- Department of Surgery, University of Texas Medical School at Houston, 6431 Fannin Street, Houston, TX 77030, USA.
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38
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Mavroeidis VK, Matthioudakis DI, Economou NK, Karanikas ID. Bouveret syndrome-the rarest variant of gallstone ileus: a case report and literature review. Case Rep Surg 2013; 2013:839370. [PMID: 23864977 PMCID: PMC3707284 DOI: 10.1155/2013/839370] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 06/15/2013] [Indexed: 12/24/2022] Open
Abstract
We present a case report of a patient with Bouveret syndrome with interesting radiological findings and successful surgical treatment after failure of the endoscopic techniques. The report is followed by a review of the literature regarding the diagnostic means and proper treatment of this rare entity. Bouveret syndrome refers to the condition of gastric outlet obstruction caused by the impaction of a large gallstone into the duodenum after passage through a cholecystoduodenal fistula. Many endoscopic and surgical techniques have been described in the management of this syndrome. This is a case of a 78-year-old patient with severe medical history who presented in bad general condition with an 8-day history of nausea, multiple bilious vomiting episodes, anorexia, discomfort in the right hypochondrium and epigastrium, and fever up to 38,5°C. The diagnosis of Bouveret syndrome was set after performing the proper imaging studies. An initial endoscopic effort to resolve the obstruction was performed without success. Surgical treatment managed to extract the impacted gallstone through an enterotomy after removal into the first part of the jejunum.
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Affiliation(s)
| | | | - Nikolaos K. Economou
- 1st Surgical Department, Sismanogleio General Hospital of Attica, 15126 Athens, Greece
| | - Ioannis D. Karanikas
- 1st Surgical Department, Sismanogleio General Hospital of Attica, 15126 Athens, Greece
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39
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Abstract
This is a case of a 59-year-old woman with Bouveret syndrome. An initial endoscopic approach to management is described. Gallstone ileus occurs when a gallstone passes from a cholecystoduodenal fistula or a choledochoduodenal fistula into the gastrointestinal tract and causes obstruction, usually at the ileocecal valve. Bouveret syndrome is a variant of gallstone ileus where the gallstone lodges in the duodenum or pylorus causing a gastric outlet obstruction. The endoscopic and surgical management of this process are important to keep in mind and may be evolving as endoscopic therapies improve.
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Zafar A, Ingham G, Jameel JKA. "Bouveret's syndrome" presenting with acute pancreatitis a very rare and challenging variant of gallstone ileus. Int J Surg Case Rep 2013; 4:528-30. [PMID: 23570683 DOI: 10.1016/j.ijscr.2013.01.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 01/24/2013] [Accepted: 01/25/2013] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Bouveret's syndrome is a rare variant of gallstone ileus and describes gastric outlet obstruction secondary to an impacted stone in the duodenum. Its presentation is vague and clinical diagnosis is often difficult resulting in a delay in diagnosis. PRESENTATION OF CASE We report a patient who presented initially with non-specific symptoms and subsequently with features in keeping with acute pancreatitis, but eventually was found to have Bouveret's syndrome. DISCUSSION Different treatment strategies are discussed. Although endoscopic treatment combined with many newer modalities like lithotripsy have been tried, surgery remains the definitive management in the vast majority of cases. CONCLUSION Bouveret's syndrome is a rare condition, can also present as pancreatitis and often difficult to diagnose initially, but with appropriate treatment has a good outcome.
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Affiliation(s)
- Arif Zafar
- Department of General & Upper Gastrointestinal Surgery, Dewsbury & District Hospital, The Mid Yorkshire Hospitals NHS Trust, Halifax Road, Dewsbury, West Yorkshire WF13 4HS, United Kingdom.
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A Rare Presentation of Xanthogranulomatous Cholecystitis as Bouveret's Syndrome. Case Rep Radiol 2012; 2012:402768. [PMID: 23346444 PMCID: PMC3546451 DOI: 10.1155/2012/402768] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Accepted: 12/08/2012] [Indexed: 12/24/2022] Open
Abstract
The purpose of this paper is to present sonographic and CT imaging findings of xanthogranulomatous cholecystitis (XGC) presented as Bouveret's syndrome, a very rare cause of gastric obstruction. While the patient's physical examination, upper GI endoscopy, and radiological findings all pointed to Bouveret's syndrome, CT differential diagnosis suggested either XGC or gallbladder carcinoma, and the final diagnosis was done histopathologically. Our paper aims to increase awareness in radiologically diagnosing XGC cases by introducing the possibility of existence of Bouveret's syndrome.
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Sliker CW, Steenburg SD, Archer-Arroyo K. Emergency radiology eponyms: part 2--Naclerio's V sign to Fournier gangrene. Emerg Radiol 2012; 20:185-95. [PMID: 23065070 DOI: 10.1007/s10140-012-1082-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 10/04/2012] [Indexed: 10/27/2022]
Abstract
An eponym is a name based on the name of a person, frequently as a means to honor him/her, and it can be used to concisely communicate or summarize a complex abnormality or injury. However, inappropriate use of an eponym may lead to potentially dangerous miscommunication. Moreover, an eponym may honor the incorrect person or a person who falls into disrepute. Despite their limitations, eponyms are still widespread in medicine. Many commonly used eponyms applied to extremity fractures should be familiar to most emergency radiologists and have been previously reported. Yet, a number of non-extremity eponyms can be encountered in an emergency radiology practice as well. This other group of eponyms encompasses a spectrum of traumatic and nontraumatic pathology. In this second part of a two-part series, the authors discuss a number of non-extremity emergency radiology eponyms, including relevant clinical and imaging features, as well biographical information of the eponyms' namesakes.
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Affiliation(s)
- Clint W Sliker
- Diagnostic Imaging Department, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD 21201, USA.
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Lee W, Han SS, Lee SD, Kim YK, Kim SH, Woo SM, Lee WJ, Koh YW, Hong EK, Park SJ. Bouveret's syndrome: a case report and a review of the literature. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2012; 16:84-7. [PMID: 26388913 PMCID: PMC4574991 DOI: 10.14701/kjhbps.2012.16.2.84] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 04/30/2012] [Accepted: 05/03/2012] [Indexed: 12/14/2022]
Abstract
Bouveret's syndrome is a gastric outlet obstruction caused by an impacted gallstone that passes through a cholecysto-gastric or cholecysto-duodenal fistula. An elderly woman visited a local clinic with nausea and abdominal pain. Abdominal computed tomography revealed a stone that was impacted in the duodenal lumen and a fistula between the gallbladder and duodenum. Malignancy could not be excluded due to the mass in the cystic duct showing enhancement and the presence of enlarged lymph nodes on computed tomography, and increased fludeoxyglucose uptake in the cystic duct on positron emission tomography. The patient underwent simultaneous cholecystectomy, segmental duodenectomy and gastro-jejunostomy. Pathological examination exhibited chronic inflammation and no primary cancer of the gallbladder and fistula.
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Affiliation(s)
- Woohyung Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Sik Han
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Seung Duk Lee
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Young-Kyu Kim
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Seong Hoon Kim
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Sang Myung Woo
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Woo Jin Lee
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Young Whan Koh
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Eun Kyung Hong
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
| | - Sang-Jae Park
- Center for Liver Cancer, National Cancer Center, Goyang, Korea
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Baloyiannis I, Symeonidis D, Koukoulis G, Zachari E, Potamianos S, Tzovaras G. Complicated cholelithiasis: an unusual combination of acute pancreatitis and bouveret syndrome. Case Rep Gastroenterol 2012; 6:459-464. [PMID: 22855661 PMCID: PMC3398075 DOI: 10.1159/000341512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Bouveret syndrome is a rare form of gallstone ileus. The purpose of the present study was to present the unusual case of a female patient with complicated cholelithiasis manifested as a combination of acute pancreatitis and concomitant Bouveret syndrome. A 61-year-old female patient was admitted to the emergency department complaining of mid-epigastric and right upper quadrant abdominal pain radiating band-like in the thoracic region of the back as well as repeated episodes of vomiting over the last 24 h. The initial correct diagnosis of pancreatitis was subsequently combined with the diagnosis of Bouveret syndrome as a computed tomography scan revealed the presence of a gallstone within the duodenum causing luminal obstruction. After failure of endoscopic gallstone removal, a surgical approach was undertaken where gallstone removal was followed by cholecystectomy and restoration of the anatomy by eliminating the fistula. The concomitant pancreatitis complicated the postoperative period and prolonged the length of hospital stay. However, the patient was discharge on the 45th postoperative day. Attempts for endoscopic removal of the impacted stone should be the initial therapeutic step. Surgery should be reserved for cases refractory to endoscopic intervention and when definite treatment is the actual challenge.
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Affiliation(s)
- Ioannis Baloyiannis
- Department of General Surgery, University Hospital of Larissa, Larissa, Greece
| | | | - Georgios Koukoulis
- Department of General Surgery, University Hospital of Larissa, Larissa, Greece
| | - Eleni Zachari
- Department of General Surgery, University Hospital of Larissa, Larissa, Greece
| | - Spyros Potamianos
- Department of Gastroenterology, University Hospital of Larissa, Larissa, Greece
| | - George Tzovaras
- Department of General Surgery, University Hospital of Larissa, Larissa, Greece
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Benghalia K, Colardelle P, Chochon M, Roussin Bretagne S, Doll J. Syndrome de Bouveret traité par lithotritie mécanique. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s10190-011-0152-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Affiliation(s)
- K Hameed
- Department of Gastroenterology, North Wales NHS Trust, UK.
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Abstract
We present the case of a 76-year-old man referred to our hospital with a round stone in central mediastinum and pneumomediastinum in chest radiography and computed tomography. He had a previous history of attempt of endoscopic retrievement of a gallstone that had caused a gastric outlet obstruction (Bouveret syndrome). To our knowledge, this is the first imaging description of mediastinal gallstone caused by esophagus perforation during complicated endoscopic lithotomy.
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Menéndez P, Gambi D, Villarejo P, Cubo T, Padilla D, Martín J. [Biliary ileus as a consequence of a cholecystoduodenal fistula (Bouveret syndrome)]. Rev Clin Esp 2009; 208:321-2. [PMID: 18620667 DOI: 10.1157/13123202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Crespo Pérez L, Angueira Lapeña T, Defarges Pons V, Foruny Olcina JR, Cano Ruiz A, Benita León V, Gónzalez Martín JA, Boixeda de Miquel D, Milicua Salamero JM. [A rare cause of gastric outlet obstruction: Bouveret's syndrome]. GASTROENTEROLOGIA Y HEPATOLOGIA 2009; 31:646-51. [PMID: 19174082 DOI: 10.1016/s0210-5705(08)75813-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Accepted: 06/10/2008] [Indexed: 12/21/2022]
Abstract
Bouveret's syndrome is a rare type of gallstone ileus in which a gallstone enters the intestinal tract via a cholecystoenteric fistula and is lodged in the duodenum or the stomach. Since the first description by León Bouveret in 1896, fewer than 200 cases have been described in the worldwide literature. Mortality is high, at 25%, but may be related to the advanced age of the typical patient and comorbidities, as well as diagnostic delay. Diagnosis may be made with radiological (abdominal X-ray, ultrasound, computed tomography or magnetic resonance imaging) and endoscopic techniques. Endoscopy is preferred as the first therapeutic option but is frequently unsuccessful and surgery is often required. We present the case of a patient admitted to hospital with a history of vomiting after eating and epigastric pain. The management of this rare cause of gastric outlet obstruction is discussed.
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Affiliation(s)
- Laura Crespo Pérez
- Servicio de Gastroenterología, Unidad de Endocscopia Digestiva, Hospital Universitario Ramón y Cajal, Madrid, Spain.
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