Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2013:2013:839370.
doi: 10.1155/2013/839370. Epub 2013 Jun 24.

Bouveret syndrome-the rarest variant of gallstone ileus: a case report and literature review

Vasileios K Mavroeidis  1 , Dimitrios I Matthioudakis, Nikolaos K Economou, Ioannis D Karanikas
Affiliations

Bouveret syndrome-the rarest variant of gallstone ileus: a case report and literature review

Vasileios K Mavroeidis et al. Case Rep Surg. 2013.

Abstract

We present a case report of a patient with Bouveret syndrome with interesting radiological findings and successful surgical treatment after failure of the endoscopic techniques. The report is followed by a review of the literature regarding the diagnostic means and proper treatment of this rare entity. Bouveret syndrome refers to the condition of gastric outlet obstruction caused by the impaction of a large gallstone into the duodenum after passage through a cholecystoduodenal fistula. Many endoscopic and surgical techniques have been described in the management of this syndrome. This is a case of a 78-year-old patient with severe medical history who presented in bad general condition with an 8-day history of nausea, multiple bilious vomiting episodes, anorexia, discomfort in the right hypochondrium and epigastrium, and fever up to 38,5°C. The diagnosis of Bouveret syndrome was set after performing the proper imaging studies. An initial endoscopic effort to resolve the obstruction was performed without success. Surgical treatment managed to extract the impacted gallstone through an enterotomy after removal into the first part of the jejunum.

PubMed Disclaimer

Figures

Figure 1
Figure 1
A plain abdominal X-ray suspecting the presence of air in the gallbladder (arrow).
Figure 2
Figure 2
Small arrow showing the presence of air in an intrahepatic bile duct. Large arrow showing gastric dilatation.
Figure 3
Figure 3
Contrast and air inside the gallbladder (arrow).
Figure 4
Figure 4
Dilatation of the duodenum (arrow).
Figure 5
Figure 5
A gallstone in the 2nd to 3rd part of the duodenum (arrow).
Figure 6
Figure 6
Five minutes after intake of the oral contrast all the anatomic elements are well visualised: (a) the gallbladder filled with contrast, (b) the cystic duct filled with contrast, (c) the cholecystoduodenal fistula, (d) a duodenal diverticulum of the 3rd part filled with contrast, and (e) a large gallstone impacted on the 2nd to 3rd part of the duodenum.
Figure 7
Figure 7
Fifteen minutes after intake of the oral contrast (a) the evacuation of the gallbladder is well seen as well as (b) the dilatation of the filled up with contrast duodenum proximally to the impacted gallstone and (c) the slight passage of the gastrografin distally to the gallstone in the 4rth part and jejunum.
Figure 8
Figure 8
A cholecystoduodenal fistula orifice noticed in the superior duodenal wall (arrow).
Figure 9
Figure 9
The proximal side of a large gallstone impacted in the 2nd to 3rd part of the duodenum (arrow).
Figure 10
Figure 10
Figure 11
Figure 11
The gallstone located in the first part of the jejunum after successful milking right before jejunotomy (arrow).
Figure 12
Figure 12
The extraction of the gallstone right after the ligament of Treitz (arrows).
See this image and copyright information in PMC

References

    1. Iñíguez A, Butte JM, Zúñiga JM, Crovari F, Llanos O. Síndrome de Bouveret. Resolución endóscopica y quirúrgica de cuatro casos clínicos. Revista Médica de Chile. 2008;136:163–168. - PubMed
    1. Sánchez Sánchez MR, Bouzón Caamaño F, Carreño Villarreal G, Alonso Blanco RA, Galarraga Gay MA, Alvarez Obregón R. Síndrome de Bouveret. A propósito de un caso. Revista Clínica Española. 2003;203:399–400. - PubMed
    1. O’Neill C, Colquhoun P, Schlachta CM, Etemad-Rezai R, Jayaraman S. Gastric outlet obstruction secondary to biliary calculi: 2 cases of Bouveret syndrome. Canadian Journal of Surgery. 2009;52(1):E16–E18. - PMC - PubMed
    1. Iancu C, Bodea R, Al Hajjar N, Todea-Iancu D, Bǎlǎ O, Acalovschi I. Bouveret syndrome associated with acute gangrenous cholecystitis. Journal of Gastrointestinal and Liver Diseases. 2008;17(1):87–90. - PubMed
    1. Masannat YA, Caplin S, Brown T. A rare complication of a common disease: bouveret syndrome, a case report. World Journal of Gastroenterology. 2006;12(16):2620–2621. - PMC - PubMed

LinkOut - more resources