Impacted duodenal gallstone presenting as gastric outlet obstruction: a rare case of Bouveret syndrome

Karadimos, Darren; Keelan, Simon; Maundura, Mandivarira; Hardley, Andrew

doi:10.1111/ans.15142

Cited by 4 publications

(2 citation statements)

References 7 publications

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“…Risk factors include gallstones greater than two centimeters in size and elderly age. Mortality can range from 12-20% with a strong associated risk of severe ascending cholangitis [1,2]. In general, gallstone ileus causes one to four percent of all cases with smallbowel obstruction, with the most prevalent region of impaction located in the distal ileus [3,4].…”

Section: Discussionmentioning

confidence: 99%

Bouveret Syndrome: A Rare Form of Gallstone Ileus

Shah¹,

Winkle²,

Truitt³

et al. 2021

Cureus

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Bouveret's syndrome is a rare variant of gallstone ileus characterized by a gastric outlet obstruction due to the impaction of a gallstone lodged in the duodenum, resulting from a cholecystoduodenal fistula. It accounts for only one to three percent of cases of gallstone ileus. We examine a case of Bouveret syndrome in an elderly Japanese female who presented with vomiting and decreased oral intake. Subsequent imaging found a gallstone ileus due to a bilioduodenal fistula. She underwent exploratory laparotomy enterolithotomy which found a large black gallstone located in the small bowel and confirmed the presence of the fistula. Despite its relative rarity, Bouveret syndrome carries a high risk of morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Bouveret Syndrome: A Rare Form of Gallstone Ileus

Shah¹,

Winkle²,

Truitt³

et al. 2021

Cureus

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“…Számos alkalommal került már ismertetésre, azonban még így is ritka kórképnek számít. 1967 és 2021 között több száz esetet mutattak be az irodalomban [2][3][4][5][6][7]. Az epekő okozta ESETISMERTETÉS ileus a bélelzáródások 1-3%-a, valamint az epekőbetegség szövődményeinek 0,3-4%-a [8,9].…”

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Bouveret-szindróma

Tóth

Penyige

Al-Droubi

et al. 2021

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Összefoglaló. A Bouveret-szindróma egy bilioenteralis fistulán keresztül a vékonybélbe – az esetek 85%-ában a duodenumba – jutó nagy epekő okozta bélelzáródást jelenti. Leggyakrabban idős nők körében fordul elő. Jelen közleményünk célja e kórkép tüneteinek, diagnosztikájának és terápiás lehetőségeinek ismertetése egy esetbemutatás kapcsán. A 79 éves nőbeteg felvételi hasi panaszainak hátterében típusos gyomorkimenet-obstrukciós szindrómát okozó, a duodenumban beékelődött epekő, Bouveret-szindróma igazolódott. A diagnózist az elvégzett natív hasi röntgen és hasi ultrahangvizsgálatok már felvetették, de megerősítésére további képalkotó vizsgálatot (hasi CT) és endoszkópos beavatkozást végeztünk. Ezt követően sebészeti beavatkozás történt, melynek során a cholecystoduodenalis fistula zárása és az epekő eltávolítása után a beteg gyógyultan távozott. Közleményünkben a diagnózisfelállítás idejének fontosságáról, illetve a terápiás lehetőségekről számolunk be, valamint szeretnénk felhívni a figyelmet az epekő okozta gyomorürülési zavar ezen ritka formájára. Orv Hetil. 2021; 162(49): 1982–1986. Summary. Bouveret syndrome is a rare form of bowel obstruction resulting to the small intestine – in 85% of the cases to the duodenum – caused by a gallstone from a bilioenteral fistula. It occurs most commonly in elderly women. The aim of the present study is to describe the symptoms, diagnostic and therapeutic options of Bouveret syndrome due to our case report. The background of epigastric pain of the 79-year-old woman was the typical gastric outlet obstruction syndrome caused by Bouveret syndrome with an impacted gallstone into the duodenum. This diagnosis was suggested by abdominal X-ray and abdominal ultrasound; however, it was confirmed with abdominal computer tomography and upper gastrointestinal endoscopy. This was followed by surgical intervention to close the cholecystoduodenal fistula and remove the gallstone, finally the cured patient was discharged. In our study, we summarize the importance of timely diagnosis and therapeutic options, respectively, furthermore, draw attention to this rare form of gallstone-caused gastric outlet obstruction syndrome. Orv Hetil. 2021; 162(49): 1982–1986.

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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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Impacted duodenal gallstone presenting as gastric outlet obstruction: a rare case of Bouveret syndrome

Cited by 4 publications

References 7 publications

Bouveret Syndrome: A Rare Form of Gallstone Ileus

Bouveret Syndrome: A Rare Form of Gallstone Ileus

Bouveret-szindróma

Post hoc validation of a tool that accurately predicts the outcome of endoscopic therapy in Bouveret syndrome

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