Bouveret’s Syndrome as a Rare Life-Threatening Complication of Gallstone Disease—A Surgical Problem: Two Case Reports
<i>Introduction</i>: Bouveret syndrome, a rare and often underdiagnosed variant of gallstone ileus, is characterized by the presence of a large gallstone impacted in the proximal duodenum, resulting in significant gastric outlet obstruction and aerobilia. Early identification of Bouveret...
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| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2024-12-01
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| Series: | Medicina |
| Subjects: | |
| Online Access: | https://www.mdpi.com/1648-9144/61/1/5 |
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| Summary: | <i>Introduction</i>: Bouveret syndrome, a rare and often underdiagnosed variant of gallstone ileus, is characterized by the presence of a large gallstone impacted in the proximal duodenum, resulting in significant gastric outlet obstruction and aerobilia. Early identification of Bouveret syndrome is crucial for developing an appropriate surgical strategy. <i>Case 1</i>: A 76-year-old female underwent a contrast-enhanced abdominal CT scan, which revealed a cholecysto-duodenal fistula with a 3.9 cm × 4.0 cm × 4.0 cm gallstone located in the proximal duodenum, along with a distended, fluid-filled stomach and aerobilia. Intraoperatively, due to chronic inflammation and adhesion between the gallbladder and duodenum, a cholecystectomy and fistula repair were performed. <i>Case 2</i>: A 72-year-old female presented with a gastroduodenal passage obstruction confirmed by imaging, which identified a duodeno-biliary fistula. The radiological examination showed oval filling defects in the duodenal bulb consistent with Bouveret’s syndrome, with the largest stone measuring approximately 6 cm in diameter. An enterotomy was performed for stone extraction and was followed by cholecystectomy and duodenal repair with omentoplasty. <i>Conclusions</i>: Bouveret’s syndrome is a rare but clinically significant condition that should be considered in patients presenting with signs of upper gastrointestinal obstruction, particularly in those with a history of chronic cholelithiasis. Early recognition and prompt surgical intervention are essential for obtaining optimal patient outcomes. |
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| ISSN: | 1010-660X 1648-9144 |