Bouveret's syndrome. An unusual localization of gallstone ileus

Abstract

This case report describes a 77-year-old male, who presented to the emergency room with symptoms of an acute proximal small bowel obstruction. Abdominal CT scan with multi-planar reconstructions led to the diagnosis of an intestinal obstruction due to impaction of a large gallstone in the second portion of the duodenum. The CT scan demonstrated a large cholecysto-duodenal fistula as the origin of the gallstone migration. Surgical treatment consisted of milking the stone down beyond the ligament of Treitz, where it was removed through a jejunal enterotomy. The postoperative course was uncomplicated. No attempt was made to repair the choledocho-duodenal fistula at the initial intervention nor subsequently, and there have been no complications due to the fistula over 36 months of follow-up observation.

Abdome agudo por obstrução por ileobiliar

“…The most frequent site of the impaction is the terminal ileum, which is the narrowest part of the small intestine 2,3,8,11,13,14 . Another site is the gastric outlet, causing stomach obstruction, which characterizes the Bouveret syndrome [15][16][17] .…”

Karewsky syndrome: A case report and review of the literature

“…Water-soluble contrast-enhanced abdominal CT is the gold standard diagnostic test for GSI with 93% sensibility [15] . It helps to establish the presence of pneumobilia [2] , cholecysto-enteric fistula [16] , the lodging site of the ectopic stone [2,5] and it dimensions [17,18] .…”

“…Once the diagnosis was made, an emergency laparotomy was performed, extracting the stone by manual compression through the anus, without repairing the fistula. Several surgical approaches have been described, such as enterolithotomy, one-step approach, and two-step approach [4,9,16,19] . However, no evidence-based recommendation has been made to describe the best procedure in GSI.…”