Bouveret’s syndrome as a rare complication of cholelithiasis: Disputes in current management and report of two cases

Evola, Giuseppe; Caramma, Sebastiano; G, Caruso; Dapri, Giovanni; Evola, Francesco Roberto; Reina, Carlo; Reina, Giuseppe Angelo

doi:10.1016/j.ijscr.2020.05.019

Cited by 14 publications

(20 citation statements)

References 12 publications

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“…Overall, 31.7% (20/63) of cases had surgery performed as first-line treatment [ 44–58 ] and 39.7% (25/63) as second-line treatment [ 6–9 , 13–15 , 18 , 21–23 , 25–30 , 32 , 37 , 39–43 ]. The median stone sizes for patients undergoing first-line surgical therapy and second-line surgical therapy were 40 mm (IQR 30–58 mm) and 50 mm (IQR 40–60 mm), respectively; the difference between both groups was not statistically significant ( P = 0.16); 96.8% (30/31) of cases that underwent laparotomy were successful (defined as relief of mechanical obstruction and discharged from hospital), whereas 27.3% (3/11) of laparoscopic cases required conversion to laparotomy.…”

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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“…A high index of suspicion is required and an early diagnosis is essential to avoid mesenteric ischemia and bowel necrosis. SBV may present either acutely (89%) due to acute vascular insufficiency or peritonitis, or else with vague symptoms and signs (abdominal pain, nausea, vomiting, abdominal distension, a decrease in flatus production) [10] that are common to others causes of gastrointestinal obstruction [11] , [12] , [13] . In our case report the patient presented symptoms and signs of gastrointestinal obstruction without peritoneal signs.…”

Section: Discussionmentioning

confidence: 99%

Jejunal volvulus within an inguinal hernia sac like as an extremely rare cause of acute mechanical gastrointestinal obstruction in adults: First literature report

Evola

Scravaglieri

Fede³

et al. 2022

International Journal of Surgery Case Reports

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“…The main controversy of surgical management lies between whether to address only the obstruction or both the obstruction and the fistula (one stage procedure). Treatment plan should be tailored to individual cases, including considerations of patient's age, comorbidities, and likelihood of recurrent biliary complications [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

A Unique Presentation of Bouveret’s Syndrome: Two Large Gallstones Obstructing Both the Gastric Outlet and the Common Bile Duct Simultaneously

Tian

Sarvepalli

Nazzal

2021

Case Reports in Surgery

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Bouveret’s syndrome refers to a gastric outlet obstruction secondary to impaction of a gallstone in the pylorus or proximal duodenum. Thus, it can be considered a very proximal form of gallstone ileus and is infrequent. We describe such a unique case that a female patient presents with Bouveret’s syndrome and concomitant common bile duct obstruction by a second gallstone. The decision over its surgical management is complicated, based on risk factors, clinical presentations, radiographic evidence, surgical risk assessment, and specific considerations tailored to individual case. Because of her stable clinical picture and low surgical risk, we proceeded with stone extractions, fistula take-down, and common bile duct exploration in a one-stage procedure. Her postoperative course was complicated by bile stained drainage through closed suction drain that resolved with conservative management.

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Bouveret’s syndrome as a rare complication of cholelithiasis: Disputes in current management and report of two cases

Cited by 14 publications

References 12 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

Jejunal volvulus within an inguinal hernia sac like as an extremely rare cause of acute mechanical gastrointestinal obstruction in adults: First literature report

A Unique Presentation of Bouveret’s Syndrome: Two Large Gallstones Obstructing Both the Gastric Outlet and the Common Bile Duct Simultaneously

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