Bouveret Syndrome: When There Are No Options

Abstract

An 85-year-old female nursing home resident presented with a medical history of dementia, stroke, hypertension, gastroesophageal reflux disease and cholethiasis. The patient was referred because of four episodes of coffee-ground emesis and symptoms of right upper quadrant abdominal pain, with no issues with bowel movements. There was limited other information available due to the underlying history of dementia. The patient's vital signs were stable. Physical examination revealed normal cardiorespiratory parameters. The abdominal examination revealed a tender right upper quadrant, with no palpable mass and the presence of bowel sounds. Laboratory investigations revealed a white blood cell count of 18.4×10 9 /L

Síndrome de Bouveret: una rara complicación de la colelitiasis. Informe de un caso y revisión de la bibliografía

“…La localización más común, en el 50 a 90% de los casos, es el íleon terminal 1 . Los litos menores de 2.5 cm pasan casi siempre a través del intestino delgado, mientras que los más grandes se quedan impactados en la salida gástrica 3 .…”

“…Léon Bouveret lo describió en 1896 en dos pacientes y es extremadamente raro. Por lo general, 1 a 4% de las obstrucciones intestinales son efecto de íleo biliar y, de éstas, 1 a 3% se deben a este síndrome 3 .…”

“…Para determinar el diagnóstico de síndrome de Bouveret, la triada de Rigler es patognomónica (neumobilia, litos biliares ectópicos y estómago dilatado); sin embargo, en una radiografía simple de abdomen está presente sólo en 30 a 35% de los casos 3 .…”

Fluoroscopic findings in Bouveret syndrome

“…As was the case in this patient, large stones may require surgery for removal. Mortality has been reported in instances in which the additional comorbidities yield the patient a nonsurgical candidate [8].…”

Bouveret's syndrome: A rare presentation of gastric outlet obstruction

“…A nasogastric tube was placed, and it drained >1 l fluid. Routine laboratory tests revealed a white blood cell count of 18.4x10 9 /l (normal range, 4.0-11.0x10 9 /l), an alkaline phosphatase level of 131 U/l (normal range, 40-120 U/l) and a γ-glutamyl transferase level of 116 U/l (normal, <37 U/l) (7). The remaining laboratory test results were unremarkable.…”