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Case Reports
. 2008 Jan 7;14(1):125-8.
doi: 10.3748/wjg.14.125.

Intermittent gastric outlet obstruction due to a gallstone migrated through a cholecysto-gastric fistula: a new variant of "Bouveret's syndrome"

Dimitry Arioli  1 , Ivo Venturini, Michele Masetti, Elisa Romagnoli, Antonella Scarcelli, Pietro Ballesini, Athos Borghi, Alessandro Barberini, Vincenzo Spina, Mario De Santis, Fabrizio Di Benedetto, Giorgio Enrico Gerunda, Maria Luisa Zeneroli
Affiliations
Case Reports

Intermittent gastric outlet obstruction due to a gallstone migrated through a cholecysto-gastric fistula: a new variant of "Bouveret's syndrome"

Dimitry Arioli et al. World J Gastroenterol. .

Abstract

Bouveret's syndrome, defined as gastric outlet obstruction due to a large gallstone, is still one of the most dramatic biliary gallstone complications. Although new radiological and endoscopic techniques have made pre-surgical diagnosis possible in most cases and the death rate has dropped dramatically, "one-stage surgery" (biliary surgery carried out at the same time as the removal of the gut obstruction) should be still considered as the gold standard for the treatment of gallstone ileus.In this case, partial gastric outlet obstruction resulted in an atypical and insidious clinical presentation that allowed us to perform the conventional one-stage laparatomic procedure that completely solved the problem, thus avoiding any further complications.

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Figures

Figure 1
Figure 1
Oesophagogastroduodenoscopy confirming the presence of a foreign body looking like a biliary stone (A) and a 15 mm-wide ulcer (B).
Figure 2
Figure 2
Computerised tomography revealing the density of foreign body typical of ectopic biliary stone (A) and the oedematous wall of the gastric antrum (B).
Figure 3
Figure 3
Magnetic resonance cholangiopancreatography showing no fistula.
Figure 4
Figure 4
One-stage surgery with dissection of omental-cholecystic adhesions.
Figure 5
Figure 5
A large ectopic stone extracted.
See this image and copyright information in PMC

Comment in

References

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