Bouveret’s syndrome: a strategic approach for management

An 81-year-old woman, diabetic and hypertensive, presented with nausea and intermittent vomiting. She had dysphagia and loss of appetite for over 6 weeks and significant weight loss over 3 weeks and was admitted in general surgery unit on emergency basis. Investigations revealed dilated stomach and a stone in first part of duodenum, with probable site of obstruction at level of first part of duodenum, secondary to a cholecystoduodenal fistula. With a preoperative diagnosis of Bouveret’s syndrome, she underwent laparotomy and subtotal cholecystectomy. Postoperative recovery was delayed due to gastroparesis and delayed gastric emptying which resolved with conservative management. Successful management of this case required a multidisciplinary team approach. Early diagnosis was the key to management. Mode of treatment and management of Bouveret’s syndrome should be tailored to suit patient’s age, comorbidities and performance status.

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Patient-reported symptom burden and quality of life in advanced lung cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e16570 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e16570-e16570

Author(s):

Shrividya Iyer ◽

Alex Rider ◽

Gavin Taylor-Stokes ◽

Adam Roughley

Keyword(s):

Quality Of Life ◽

Lung Cancer ◽

Performance Status ◽

Symptom Burden ◽

Shortness Of Breath ◽

Patient Reported ◽

And Performance ◽

Loss Of Appetite ◽

Nsclc Patients

e16570 Background: The main objective of our study was to assess patient reported symptom burden and impact on quality of life in advanced non small cell lung cancer (NSCLC) patients in the United States. Methods: Patients with advanced (stage IIIB/IV) NSCLC (N=450) were recruited with informed consent in a nationwide (US) lung cancer study from Oct-Dec 2011. Patient reported symptoms were assessed using the Lung Cancer Symptom Scale (LCSS) on a 0-100 visual analogue scale and included six symptoms: fatigue, appetite loss, shortness of breath, cough, pain and blood in sputum. An average symptom burden index was calculated. Quality of life was assessed using the Functional Assessment of Cancer Therapy- Lung (FACT-L).Higher scores indicate higher symptom severity on the LCSS and better quality of life on the FACT-L. Correlation between the total FACT-L score and LCSS symptom burden index was assessed. A multivariate regression analysis was performed with FACT-L total score as the dependent variable and LCSS symptom scores as predictors controlling for age, gender, stage and performance status. Results: Majority of the patients were male (59%), Caucasian (74%), smokers/ex-smokers (78%) with an average age of 64 years. Proportion of patients reporting each lung cancer symptom was: Fatigue (100%), loss of appetite (97%), shortness of breath (95%), cough (93%), pain (92%) and blood in sputum (63%). The average (SD) symptom burden index was 42.3 (21.5).The mean± SD severity scores on symptoms were: fatigue (53.2±24.7), loss of appetite (48.1±25.8), cough (48.4±29.9), shortness of breath (44.7± 27), pain (39.7± 28.1) and blood in sputum (18.4±23.6). The average (SD) FACT-L score was 71.7 (25.3). A significant negative correlation was found between the LCSS symptom burden index and FACT-L scores (ρ= -0.82; p<0.001). Loss of appetite (β=-0.204; p<0.001), cough (β= -0.145; p<0.01), pain (β=-0.265; p<0.001), shortness of breath (β = -0.145; p<0.01), age (β= 0.217; p<0.05) and performance status (β = 0.283; p<0.001) were found to be significant predictors of quality of life. Conclusions: Cough, pain, shortness of breath and loss of appetite contribute to symptom burden and have a significant negative impact on quality of life in advanced NSCLC patients.

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Bouveret's Syndrome: An Overlooked Diagnosis. A Case Report and Review of Literature

International Surgery ◽

10.9738/intsurg-d-14-00087.1 ◽

2014 ◽

Vol 99 (6) ◽

pp. 819-823 ◽

Cited By ~ 22

Author(s):

Ghazi Raji Qasaimeh ◽

Sohail Bakkar ◽

Khaled Jadallah

Keyword(s):

Gall Bladder ◽

Gastric Outlet Obstruction ◽

Elective Surgery ◽

Outlet Obstruction ◽

Postoperative Recovery ◽

Bladder Stone ◽

Endoscopic Management ◽

Bouveret’S Syndrome ◽

Epinephrine Injection ◽

Bouveret's Syndrome

Abstract Bouveret's syndrome is a rare cause of gastric outlet obstruction. Its diagnosis is often delayed or overlooked. It is characterized by the passage of a large gall bladder stone through a bilio-duodenal fistula, which becomes lodged in the duodenum causing duodenal obstruction. We report the case of a 70-year-old male with a history suggestive of gall bladder disease over a 1-year period. The diagnosis was confirmed by ultrasound, which showed a single large gall bladder stone and the patient was planned for elective laparoscopic cholecystectomy. One week prior to the elective surgery he presented with upper gastrointestinal bleeding for which he was admitted, diagnosed by a gastroenterologist as bleeding duodenal ulcer and treated by local epinephrine injection and blood transfusion. One week later he presented with a picture of acute gastric outlet obstruction, which proved by endoscopy to be due to a large stone impacted in the duodenum. Endoscopic management failed and the stone was managed by open surgery. The patient made a good postoperative recovery and for the last year he has remained free of symptoms.

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Bouveret’s syndrome: A challenging case of gastric outlet obstruction.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.06.3894 ◽

2020 ◽

Vol 27 (06) ◽

pp. 1316-1319

Author(s):

Marrium Gul ◽

Irfan Qadir ◽

Muhammad Qasim Butt

Keyword(s):

Gastric Outlet Obstruction ◽

Epigastric Pain ◽

Duodenal Bulb ◽

Outlet Obstruction ◽

Postoperative Recovery ◽

Blood Analysis ◽

Bouveret’S Syndrome ◽

Endoscopic Extraction ◽

Bilioenteric Fistula ◽

Bouveret's Syndrome

Bouveret’s syndrome causes gastric outlet obstruction when a gallstone is impacted in the duodenum or stomach via a bilioenteric fistula. We present case of a 40-year-old female presented with epigastric pain and intractable vomiting for 2 days. Her physical examination and laboratory workup including blood analysis, amylase test and lipase test were normal. Plain abdominal X-ray did not show any signs of small bowel obstruction. A nasogastric tube was placed and drained 2.5 L of gastric contents immediately. Esophagogastroduodenoscopy showed a dilated stomach with excessive secretions and a large blackish-brown hard stone in the duodenal bulb. After failed attempt at endoscopic extraction, patient underwent laparotomy and removal of stone via duodenal incision. Subsequently, the patient exhibited a good postoperative recovery. The condition of the patient has remained stable after being followed up for one year.

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01 / DEVELOPMENT OF MINI-COMPREHENSIVE GERIATRIC ASSESSMENT FOR THE ELDERLY CANCER PATIENTS BASED ON RELATIONSHIPS BETWEEN COMPREHENSIVE GERIATRIC ASSESSMENT ITEMS AND PERFORMANCE STATUS

10.26226/morressier.5afadd8bf314ac000849b31c ◽

2018 ◽

Author(s):

hun mo ryoo

Keyword(s):

Cancer Patients ◽

Geriatric Assessment ◽

Comprehensive Geriatric Assessment ◽

Performance Status ◽

The Elderly ◽

Elderly Cancer Patients ◽

And Performance

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Bouveret’s Syndrome – Case Series with Therapeutic Implications

Zeitschrift für Gastroenterologie ◽

10.1055/a-1113-7966 ◽

2020 ◽

Vol 58 (04) ◽

pp. 352-356

Author(s):

Tobias Kukiolka ◽

Jan Borovicka ◽

Stephan Baumeler ◽

Marc Schiesser ◽

Christoph Gubler

Keyword(s):

Balloon Dilatation ◽

Rare Complication ◽

Gallstone Disease ◽

Treatment Algorithm ◽

Case Series ◽

Endoscopic Technique ◽

Bouveret’S Syndrome ◽

Therapeutic Implications ◽

Electrohydraulic Lithotripsy ◽

Bouveret's Syndrome

AbstractBouveret’s syndrome is a rare complication resulting from gallstone disease. Both surgical and endoscopical procedures are performed, with the disease to be seen as strictly interdisciplinary. There are no well-established recommendations for this condition. In this paper, we want to describe our experience from 6 cases in 3 Swiss hospitals from 2015 to 2017 with emphasis on the endoscopic technique of electrohydraulic lithotripsy followed by balloon dilatation and propose a treatment algorithm.

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Migrating Gallstone: From Bouveret's Syndrome to Distal Small Bowel Obstruction

Journal of Laparoendoscopic & Advanced Surgical Techniques ◽

10.1089/lap.2006.16.256 ◽

2006 ◽

Vol 16 (3) ◽

pp. 256-260 ◽

Cited By ~ 2

Author(s):

Kwok-Kay Yau ◽

Wing-Tai Siu ◽

Ka-Kin Tsui

Keyword(s):

Small Bowel ◽

Small Bowel Obstruction ◽

Bowel Obstruction ◽

Bouveret’S Syndrome ◽

Distal Small Bowel ◽

Bouveret's Syndrome

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Prognostic value of blood-based fibrosis biomarkers in patients with metastatic colorectal cancer receiving chemotherapy and bevacizumab

Scientific Reports ◽

10.1038/s41598-020-79608-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Neel I. Nissen ◽

Stephanie Kehlet ◽

Mogens K. Boisen ◽

Maria Liljefors ◽

Christina Jensen ◽

...

Keyword(s):

Colorectal Cancer ◽

Metastatic Colorectal Cancer ◽

Collagen Type ◽

Performance Status ◽

Drug Uptake ◽

Collagen Type Iii ◽

Serum Samples ◽

Type Iii ◽

Poor Treatment ◽

And Performance

AbstractA desmoplastic colorectal cancer stroma, characterized by excess turnover of the cancer-associated fibroblast derived collagens type III and VI, can lead to reduced drug-uptake and poor treatment response. We investigated the association between biomarkers of collagen type III and VI and overall survival (OS) in patients with metastatic colorectal cancer (mCRC). Serum samples were collected from 252 patients with mCRC prior to treatment with bevacizumab and chemotherapy. Serum concentrations of biomarkers reflecting formation of collagen type III (PRO-C3) and VI (PRO-C6) and degradation of collagen type VI (C6M and C6Mα3) were determined by ELISA. The biomarkers were evaluated for associations with OS, individually, combined, and after adjusting for carcinoembryonic antigen (CEA), lactate dehydrogenase (LDH) and performance status (PS). High baseline levels (> median) of each collagen biomarker were significantly associated with shorter OS (PRO-C3: HR = 2.0, 95%CI = 1.54–2.63; PRO-C6: HR = 1.6, 95%CI = 1.24–2.11; C6M: HR = 1.4, 95%CI = 1.05–1.78; C6Mα3: HR = 1.6, 95%CI = 1.16–2.07). PRO-C3 and PRO-C6 remained significant after adjustment for CEA, LDH and PS. Weak correlations were seen between the collagen biomarkers (r = 0.03–0.59) and combining all improved prognostic capacity (HR = 3.6, 95%CI = 2.30–5.76). Collagen biomarkers were predictive of shorter OS in patients with mCRC. This supports that collagen- and CAF biology is important in CRC.

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