Bouveret syndrome: a rare form of gallstone ileus

2021 ◽  
Vol 14 (2) ◽  
pp. e238126
Author(s):  
Don Haering ◽  
Mattie Murphy ◽  
John Craig ◽  
Gavin A Falk
Keyword(s):  
Clinical Evidence ◽  
Incidental Finding ◽  
Gallstone Ileus ◽  
Definitive Treatment ◽  
Abdominal Radiograph ◽  
Quadrant Pain ◽  
Abdominal Ct Scan ◽  
History Of ◽  
Bouveret Syndrome ◽  
High Index Of Suspicion

A 57-year-old woman presented with a 5-day history of worsening right upper quadrant pain, bilious emesis and approximately 20 pounds of weight loss. The patient was afebrile, without jaundice and had mild tenderness in her right upper quadrant. She noted an incidental finding of asymptomatic cholelithiasis on imaging 4 years earlier. An abdominal radiograph revealed pneumobilia and a large ectopic calculus. An abdominal CT scan confirmed pneumobilia, a large concretion completely obstructing the third portion of the duodenum and a soft tissue communication between the gallbladder and proximal duodenum. She was brought to the operating room for definitive treatment and had the obstructing gallstone removed via a transverse duodenotomy. Bouveret syndrome is a rare cause of small bowel obstruction that requires a high index of suspicion for diagnosis. It should be considered in older patients with clinical evidence of gastric or duodenal obstruction, particularly with a history of cholelithiasis.

scholarly journals Bile Salt Enterolith: An Unusual Etiology Mimicking Gallstone Ileus

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Dana Ferrari-Light ◽  
Ariel Shuchleib ◽  
Joel Ricci-Gorbea
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Surgical Intervention ◽  
Gallstone Ileus ◽  
Duodenal Diverticulum ◽  
Multiple Risk Factors ◽  
History Of ◽  
High Index Of Suspicion ◽  
Distal Jejunum

Primary enterolithiasis is a relatively uncommon but important cause of small bowel obstruction. We present a case of a 69-year-old male with a history of laparoscopic Roux-en-Y gastric bypass and asymptomatic duodenal diverticulum diagnosed with small bowel obstruction. CT imaging showed an obstruction distal to the jejunojejunostomy, and surgical intervention was warranted. A 4.5 cm enterolith removed from the distal jejunum was found to contain 100% bile salts, consistent with a primary enterolith. Clinicians should retain a high index of suspicion for enteroliths as a cause of small bowel obstruction, especially if multiple risk factors for enterolith formation are present.

scholarly journals Detection and Management of Intraoperative Pneumothorax during Laparoscopic Cholecystectomy

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Mohammed Heyba ◽  
Areej Rashad ◽  
Abdul-Aziz Al-Fadhli
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
General Anesthesia ◽  
Preoperative Assessment ◽  
Definitive Treatment ◽  
Diagnostic Tools ◽  
Low Oxygen ◽  
Good Communication ◽  
Chest Auscultation ◽  
History Of ◽  
High Index Of Suspicion

Intraoperative pneumothorax is a rare but potentially lethal complication during general anesthesia. History of lung disease, barotrauma, and laparoscopic surgery increase the risk of developing intraoperative pneumothorax. The diagnosis during surgery could be difficult because the signs are often nonspecific. We report a case of a middle-aged gentleman who developed right pneumothorax during an elective laparoscopic cholecystectomy. The patient had no risk factors for adverse events during the preoperative assessment (ASA1). The patient underwent general anesthesia and was put on mechanical ventilation. The first signs of abnormality immediately after surgical port insertion were tachycardia and low oxygen saturation in addition to sings of airway obstruction. The diagnosis of pneumothorax was made clinically by chest auscultation and later confirmed by intraoperative chest radiograph. Supportive treatment was started immediately through halting the surgery and manually ventilating the patient using 100% oxygen. Definitive treatment was then done by inserting an intercostal tube. After stabilizing the patient, the surgery was completed; then, the patient was extubated and shifted to the surgical ward. Postoperative computed tomography (CT) scan was done and showed only minimal liver laceration. The patient was discharged after removing the intercostal tube and was stable at the follow-up visit. Therefore, it is important to have a high index of suspicion to early detect and treat such complication. In addition, good communication with the surgeon and use of available diagnostic tools will aid in the proper management of such cases.

scholarly journals Gallstone ileus managed with enterolithotomy

2019 ◽  
Vol 12 (10) ◽  
pp. e231581 ◽  
Author(s):  
Louise Dunphy ◽  
Ihsan Al-Shoek
Keyword(s):  
Small Bowel ◽  
Bowel Obstruction ◽  
Clinical Presentation ◽  
Gallstone Ileus ◽  
Gallstone Disease ◽  
Abdominal Radiograph ◽  
Ileocaecal Valve ◽  
History Of ◽  
Mechanical Bowel Obstruction ◽  
Pacemaker Insertion

Although gallstone disease is classically associated with the inflammatory sequela of cholecystitis, other presentations include gallstone ileus, Mirizzi syndrome, Bouveret syndrome and gallstone ileus. Gallstone ileus occurs when a gallstone passes from a cholecystoduodenal fistula into the gastrointestinal tract and causes obstruction, usually at the ileocaecal valve. It represents an uncommon complication of cholelithiasis, accounting for 1%–4% of all cases of mechanical bowel obstruction and 25% of all cases in individuals aged >65 years. It has a female predilection. Clinical presentation depends on the site of the obstruction. Diagnosis can prove challenging with the diagnosis rendered in 50% of cases intraoperatively. The authors present the case of a 79-year-old woman with a 10-day history of abdominal pain, nausea, vomiting and episodes of loose stools. An abdominal radiograph showed mildly distended right small bowel loops. Further investigation with a CT of the abdomen and pelvis demonstrated small bowel obstruction secondary to a 3.3 cm calculus within the small bowel. She underwent a laparotomy and a 5.0×2.5 cm gallstone was evident, causing complete obstruction. An enterolithotomy was performed. Her postoperative course was complicated by Mobitz type II heart block requiring pacemaker insertion. This paper will provide an overview of the clinical presentation, investigations and management of gallstone ileus. It provides a cautionary reminder of considering gallstone ileus in the differential diagnosis in elderly patients presenting with bowel obstruction and a history of gallstone disease.

scholarly journals Bouveret Syndrome—The Rarest Variant of Gallstone Ileus: A Case Report and Literature Review

2013 ◽  
Vol 2013 ◽  
pp. 1-6 ◽  
Author(s):  
Vasileios K. Mavroeidis ◽  
Dimitrios I. Matthioudakis ◽  
Nikolaos K. Economou ◽  
Ioannis D. Karanikas
Keyword(s):  
Case Report ◽  
Surgical Treatment ◽  
Gallstone Ileus ◽  
Surgical Techniques ◽  
Outlet Obstruction ◽  
Cholecystoduodenal Fistula ◽  
Endoscopic Techniques ◽  
History Of ◽  
Bouveret Syndrome ◽  
The Right

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.

scholarly journals Severe primary hypothyroidism in an apparently asymptomatic 19-year-old woman: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Rania Dannan ◽  
Sulaiman Hajji ◽  
Khaled Aljenaee
Keyword(s):  
Incidental Finding ◽  
Clinical Manifestations ◽  
Signs And Symptoms ◽  
Thyroid Stimulating Hormone ◽  
Primary Hypothyroidism ◽  
Conflicting Evidence ◽  
Thyroid Function Testing ◽  
History Of ◽  
Asymptomatic Individuals ◽  
High Index Of Suspicion

Abstract Background Hypothyroidism is diagnosed on the basis of laboratory tests because of the lack of specificity of the typical clinical manifestations. There is conflicting evidence on screening for hypothyroidism. Case presentation We report a case of an apparently healthy 19-year-old Kuwaiti woman referred to our clinic with an incidental finding of extremely high thyroid-stimulating hormone (TSH), tested at the patient’s insistence as she had a strong family history of hypothyroidism. Despite no stated complaints, the patient presented typical symptoms and signs of hypothyroidism on evaluation. Thyroid function testing was repeated by using different assays, with similar results; ultrasound imaging of the thyroid showed a typical picture of thyroiditis. Treatment with levothyroxine alleviated symptoms and the patient later became biochemically euthyroid on treatment. Conclusion There is controversy regarding screening asymptomatic individuals for hypothyroidism; therefore, it is important to maintain a high index of suspicion when presented with mild signs and symptoms of hypothyroidism especially with certain ethnic groups, as they may be free of the classical symptoms of disease.

Adrenal Carcinoma and Hypertension Presenting with Catatonic Stupor

1996 ◽  
Vol 30 (1) ◽  
pp. 146-149 ◽  
Author(s):  
Paul Steinberg
Keyword(s):  
Clinical Evidence ◽  
Severe Hypertension ◽  
Psychosocial Stressors ◽  
Adrenal Carcinoma ◽  
Medical Patients ◽  
Psychiatric Condition ◽  
Psychiatric Disturbance ◽  
Organic Mental Disorder ◽  
History Of ◽  
High Index Of Suspicion

A case of adrenal carcinoma with severe hypertension referred for treatment of “catatonia” illustrates the need for a high index of suspicion of organic mental disorder in medical patients, even when there is clinical evidence of a psychiatric condition and a history of psychosocial stressors. This case illustrates the need for concurrent medical and psychiatric investigation when there is a problem differentiating medical from psychiatric disturbance.

Bouveret syndrome: a clinicoradiological perspective

2020 ◽  
Vol 13 (12) ◽  
pp. e238620
Author(s):  
Elliot W Checkley ◽  
Vartan Balian ◽  
Abdul Aziz ◽  
Fred Lee
Keyword(s):  
Acute Cholecystitis ◽  
Medical History ◽  
Rare Variant ◽  
Epigastric Pain ◽  
Gallstone Ileus ◽  
Outlet Obstruction ◽  
Successful Outcome ◽  
Radiological Imaging ◽  
History Of ◽  
Bouveret Syndrome

An 87-year-old woman presented to us with a 5-day history of worsening epigastric pain and vomiting. Her medical history included known gallstones and a previous episode of acute cholecystitis complicated by a perforated gallbladder for which she had declined surgery 5 years prior. Radiological imaging confirmed a large gallstone impacted in the first part of the duodenum with gross gastric outlet obstruction and pneumobilia, confirming the diagnosis of Bouveret syndrome, an often overlooked and rare variant of gallstone ileus. Following an unsuccessful oesophagogastroduodenoscopy for stone retrieval, she underwent a laparotomy and gastrotomy with a successful outcome and discharged from hospital 4 weeks following the procedure.

scholarly journals The Regularity of the Site of Impaction in Recurrent Gallstone Ileus: A Systematic Review and Meta-Analysis of Reported Cases

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Nasser A. N. Alzerwi ◽  
Bandar Idrees ◽  
Saeed Alsareii ◽  
Yaser Aldebasi ◽  
Afnan Alsultan
Keyword(s):  
Mortality Rate ◽  
Older Women ◽  
Meta Analysis ◽  
Gallstone Ileus ◽  
Final Analysis ◽  
Pooled Analysis ◽  
Paired Data ◽  
History Of ◽  
High Index Of Suspicion ◽  
Overall Mortality

Objective. Due to the rarity of recurrent gallstone ileus (RGSI), its epidemiological and clinical features are elusive. With a focus on mortality and the site of impaction, this study consolidates the key clinical characteristics of index GSI (IGSI) and RGSI. Methods. A meta-analysis of cases reported on RGSI was performed. Risk factors for mortality and site of impaction were examined, and a subgroup analysis was performed for age, sex, and site of impaction (jejunum, ileum, or others). Results. In the final analysis, 50 (56 individual cases) studies were included. The paired data for the site of impaction was available for 45 patients. Women accounted for 87.3% of all RGSI cases included in the pooled analysis. The median age (interquartile range, IQR) of the patients was 70 (63–76) years, and the median time of recurrence (IQR) was 20.5 (8.5–95.5) days. The overall mortality rate was 11.8%, without correlation between the mortality rate and age, the time of recurrence, or the site of impaction. The region in which the stone was found in RGSI and IGSI was similar in most cases p = 0.002 . Logistic regression also revealed a higher probability of stone impaction in the ileum in RGSI if it was the site of impaction in IGSI. In most cases, enterolithotomy was the preferred method. Conclusions. A high index of suspicion for RGSI should be maintained for older women with a history of GSI. The region where the stone was impacted during IGSI should be investigated first in such patients.

A Rare Case of Bilateral Incarcerated Obturator Hernias and a Right-Side Femoral Hernia

2020 ◽  
pp. 1-3
Author(s):  
Jinping Xu ◽  
Jinping Xu ◽  
Ruth Wei ◽  
Salieha Zaheer
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Femoral Hernia ◽  
Rare Case ◽  
Hernia Recurrence ◽  
High Morbidity ◽  
Diagnostic Challenge ◽  
Abdominal Ct ◽  
Abdominal Ct Scan ◽  
History Of

Obturator hernias are rare but pose a diagnostic challenge with relatively high morbidity and mortality. Our patient is an elderly, thin female with an initial evaluation concerning for gastroenteritis, and further evaluation revealed bilateral incarcerated obturator hernias, which confirmed postoperatively as well as a right femoral hernia. An 83-year-old female presented to the outpatient office initially with one-day history of diarrhea and one-week history of episodic colicky abdominal pain. She returned 4 weeks later with diarrhea resolved but worsening abdominal pain and left inner thigh pain while ambulating, without changes in appetite or nausea and vomiting. Abdominal CT scan then revealed bilateral obturator hernias. Patient then presented to the emergency department (ED) due to worsening pain, and subsequently underwent hernia repair. Intraoperatively, it was revealed that the patient had bilateral incarcerated obturator hernias and a right femoral hernia. All three hernias were repaired, and patient was discharged two days later. Patient remained well postoperatively, and 15-month CT of abdomen showed no hernia recurrence.

CASE REPORT: RARE FORM OF HIRSCHPRUNG’S DISEASE

2020 ◽  
Vol 30 (5) ◽  
pp. 82-84
Author(s):  
Ilja Skalskis
Keyword(s):  
Down Syndrome ◽  
Case Report ◽  
Clinical Symptoms ◽  
Hirschsprung Disease ◽  
Distal Colon ◽  
Total Colonic Aganglionosis ◽  
Sphincter Function ◽  
Anal Sphincter Function ◽  
History Of ◽  
High Index Of Suspicion

Hirschsprung disease (HD) is a developmental disorder characterized by the absence of ganglia in the distal colon, resulting in a functional obstruction. Incidence of total colonic aganglionosis (TCA) is 1 in 500 000 and it accounts for 5-10% of all cases of HD. HD should be suspected in patients with typical clinical symptoms and a high index of suspicion is appropriate for infants with a predisposing condition such as Down Syndrome (DS), or for those with a family history of HD. The treatment of choice for HD is surgical, such as Swenson, Soave, and Duhamel procedures. The goals are to resect the affected segment of the colon, bring the normal ganglionic bowel down close to the anus, and preserve internal anal sphincter function. We present a clinical case report of TCA in a child with Down syndrome (DS) and review of literature.

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