Bouveret syndrome: current management strategies

Caldwell, Kelly M.; Lee, Seeyuen J; Leggett, Phillip L; Bajwa, Kulvinder S.; Mehta, Shivani; Shah, Shinil K.

doi:10.2147/ceg.s132069

Cited by 108 publications

(177 citation statements)

References 38 publications

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“…Moreover, most patients have other medical comorbidities, which makes timely diagnosis and management even more challenging. 1,2,4 Several endoscopic, laparoscopic and open surgical techniques have been described in the literatures for managing Bouveret's syndrome. However, given the rarity of the condition, its variable clinical presentations and the complexity of its management, there are no specific set of guidelines or protocol to help with its diagnosis and management.…”

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confidence: 99%

“…5 In a comprehensive review of 128 patients The management of patients with Bouveret's syndrome is complex, and many endoscopic, surgical, or combination techniques can be used, with varying success rates. 2,4,7 The choice of a treatment modality depends on many factors, including the patient's age and comorbidities, the location of the obstruction, the resources availability, and the clinicians' level of expertise. 7 Here we propose an approach based on some of these factors that can guide the selection of the appropriate treatment strategy ( Figure 5).…”

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confidence: 99%

“…However, success rates significantly drop significantly if the impacted stones are larger than 3 cm in size. 2,4,7 If this fails other endoscopic techniques can be considered before surgery. 4,7 While an endoscopy is an ideal option in stable patients wishing to avoid surgery, it has its limitations.…”

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confidence: 99%

“…2,4,7 If this fails other endoscopic techniques can be considered before surgery. 4,7 While an endoscopy is an ideal option in stable patients wishing to avoid surgery, it has its limitations. Its failure to retrieve stones (the success rate is reported to be less than 20%), the need for more than one procedure, complications such as esophageal perforation, hemorrhage, the distal migration of stones with the subsequent development of gallstone ileus, and an inability to repair fistulas during endoscopy are among the many well-described limitations of endoscopic intervention.…”

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confidence: 99%

“…Its failure to retrieve stones (the success rate is reported to be less than 20%), the need for more than one procedure, complications such as esophageal perforation, hemorrhage, the distal migration of stones with the subsequent development of gallstone ileus, and an inability to repair fistulas during endoscopy are among the many well-described limitations of endoscopic intervention. 4,7 Historically, surgery has been the mainstay of treatment for Bouveret's syndrome, with 91% of patients eventually requiring surgery at some point. Its success rate has been reported to be as high as 84% in some case series.…”

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confidence: 99%

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Management of Bouveret's syndrome

Abdallah

Atiq

Kushnir

et al. 2019

J of Digest Diseases

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confidence: 99%

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confidence: 99%

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confidence: 99%

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confidence: 99%

mentioning

confidence: 99%

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Management of Bouveret's syndrome

Abdallah

Atiq

Kushnir

et al. 2019

J of Digest Diseases

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Bouveret's syndrome: A rare case of gallstone causing gastric outlet obstruction

Sabir,

Mushtaq,

Arshad

et al. 2024

Clinical Case Reports

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Key Clinical MessageThe case highlights the importance of decisive action in addressing large gallstones causing gastric outlet obstruction. The chosen single‐stage surgical approach reflects the need to manage both obstruction and the gallstone simultaneously.AbstractBouveret's syndrome is a rare cause of gastric outlet obstruction secondary to gallstones entering the enteric system through an acquired cholecystoduodenal fistula. Here, we present the case of an 85‐year‐old female who presented to our emergency department with gastric outlet obstruction secondary to a large gallstone in the third part of the duodenum. Abdominal X‐ray did not demonstrate air‐fluid levels but revealed a dilated gastric shadow, suggesting gastric outlet obstruction. EGD showed a dilated stomach and a hard, golf ball‐sized gallstone in the duodenum. CT scan showed a distended stomach with a large gallstone obstructing the DJ junction and air in the biliary tree. Findings were suggestive of perforation of the gallbladder with stone impaction in the duodenojejunal (DJ) junction. The patient was managed surgically with a one‐stage procedure comprising enterotomy, fistula closure, and cholecystectomy. Although Bouveret's syndrome is rare, it is important for practicing surgeons to have a high index of suspicion for this condition due to the high mortality associated with it.

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Endoscopic treatment of Bouveret syndrome with a combination of electrohydraulic lithotripsy and balloon expansion: A case report

et al. 2023

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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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Bouveret syndrome: current management strategies

Cited by 108 publications

References 38 publications

Management of Bouveret's syndrome

Management of Bouveret's syndrome

Bouveret's syndrome: A rare case of gallstone causing gastric outlet obstruction

Endoscopic treatment of Bouveret syndrome with a combination of electrohydraulic lithotripsy and balloon expansion: A case report

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