Erodes and bleeds, fistulises and obstructs: Bouveret’s syndrome

2020 ◽  
Vol 50 (4) ◽  
pp. 383-385
Author(s):  
Rinkal B Kakadiya ◽  
Uttam Thakur ◽  
Lileshwar Kaman ◽  
Harshal S Mandavdhare
Keyword(s):  
Gallstone Ileus ◽  
Outlet Obstruction ◽  
Bouveret’S Syndrome ◽  
Artery Pseudoaneurysm ◽  
Contrast Enhanced ◽  
Complications Of Cholelithiasis ◽  
Enhanced Computed Tomography ◽  
Bouveret's Syndrome ◽  
Contrast Enhanced Computed Tomography ◽  
Upper Gastrointestinal

One of the rare complications of cholelithiasis is gallstone ileus which occurs in <5% of patients. Among them, <3% develop Bouveret’s syndrome: gastric outlet obstruction by a large gallstone in the pylorus or duodenum. One large review of 128 patients showed it to present at a mean age of 74.1 ± 11.1 years with a mean gallstone size of 4.6 ± 1.5 cm, with nausea or vomiting in 86%, abdominal pain in 71% and haematemesis in 15%. The diagnosis is usually clear on oesophagogastroduodenoscopy or abdominal contrast-enhanced computed tomography. We present a case with massive upper gastrointestinal bleeding, due to erosion of a cystic artery pseudoaneurysm.

scholarly journals A Unique Presentation of Bouveret’s Syndrome: Two Large Gallstones Obstructing Both the Gastric Outlet and the Common Bile Duct Simultaneously

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Yuqian Tian ◽  
Neha Sarvepalli ◽  
Mustafa Nazzal
Keyword(s):  
Bile Duct ◽  
Common Bile Duct ◽  
Gallstone Ileus ◽  
Outlet Obstruction ◽  
Individual Case ◽  
Common Bile Duct Exploration ◽  
Bouveret’S Syndrome ◽  
Surgical Risk ◽  
Closed Suction Drain ◽  
Bouveret's Syndrome

Bouveret’s syndrome refers to a gastric outlet obstruction secondary to impaction of a gallstone in the pylorus or proximal duodenum. Thus, it can be considered a very proximal form of gallstone ileus and is infrequent. We describe such a unique case that a female patient presents with Bouveret’s syndrome and concomitant common bile duct obstruction by a second gallstone. The decision over its surgical management is complicated, based on risk factors, clinical presentations, radiographic evidence, surgical risk assessment, and specific considerations tailored to individual case. Because of her stable clinical picture and low surgical risk, we proceeded with stone extractions, fistula take-down, and common bile duct exploration in a one-stage procedure. Her postoperative course was complicated by bile stained drainage through closed suction drain that resolved with conservative management.

scholarly journals Bouveret’s Syndrome: A Case Report and a Brief Literature Review

2020 ◽  
Vol 33 (5) ◽  
pp. 347
Author(s):  
Rita Peixoto ◽  
Joana Correia ◽  
Mário Guimarães Soares ◽  
António Gouveia
Keyword(s):  
Case Report ◽  
Diagnostic Tests ◽  
Gallstone Ileus ◽  
Outlet Obstruction ◽  
Exploratory Laparotomy ◽  
The Elderly ◽  
Cholecystoduodenal Fistula ◽  
Bouveret’S Syndrome ◽  
Clinical Surveillance ◽  
Bouveret's Syndrome

Bouveret’s syndrome is a rare cause of gastric outlet obstruction. We report a case of a 68-year-old woman admitted with upper digestive obstruction. A few months later, and after several diagnostic tests and clinical surveillance, a cholecystoduodenal fistula was suspected. During exploratory laparotomy, the diagnosis of Bouveret’s syndrome was confirmed and a pyelolithotomy, pyloroplasty and a cholecystectomy were performed. The patient was asymptomatic 7 months after the operation. This syndrome represents only 1% - 3% of all cases of gallstone ileus, being more frequent in women and in the elderly. The presentation is quite nonspecific, but in most cases the symptomatology suggests an upper digestive occlusion. Treatment can be achieved by lithotripsy, but most patients require a surgical approach.

scholarly journals Exploring the Diagnosis and Management of Bouveret's Syndrome

2016 ◽  
Vol 54 (201) ◽  
pp. 33-35 ◽  
Author(s):  
Mukul Bhattarai ◽  
Pardeep Bansal ◽  
Bharat Patel ◽  
Alexander Lalos
Keyword(s):  
Clinical Practice ◽  
Gallstone Ileus ◽  
Gall Stone ◽  
Outlet Obstruction ◽  
Exploratory Laparotomy ◽  
Fistula Repair ◽  
Bouveret’S Syndrome ◽  
Abdominal Symptoms ◽  
History Of ◽  
Bouveret's Syndrome

Bouveret’s syndrome is an unusual cause of gastric outlet obstruction secondary to gallstone impaction. It is so rare that it is commonly missed in clinical practice if it is not considered in differential diagnoses of intestinal obstruction more specifically in man who does not report the history of gall stone. Furthermore, there are no definitive guidelines on approach and management of this condition. We present a seventy eight year old man who developed acute abdominal symptoms due to impaction of a gallstone in the duodenum. He did not have history of gall stone. The diagnosis was supported via CT abdomen and Endoscopy. The patient was successfully managed by exploratory laparotomy followed by anterior pylorotomy to remove the stone without cholecystectomy and fistula repair. Keywords: Bouveret’s syndrome; cholelithiasis; enterolithotomy; Gallstone ileus. | PubMed

Gallstone Ileus Presenting as Gastric Outlet Obstruction (Bouveret’s Syndrome): a Case Report

2006 ◽  
Vol 106 (4) ◽  
pp. 438-440 ◽  
Author(s):  
A. Sakarya ◽  
M.Y. Erhan ◽  
H. Aydede ◽  
E. Kara ◽  
M. Ozkol* ◽  
...  
Keyword(s):  
Case Report ◽  
Gastric Outlet Obstruction ◽  
Gallstone Ileus ◽  
Outlet Obstruction ◽  
Bouveret’S Syndrome ◽  
Bouveret's Syndrome

Gastric lipoma: a rare cause of massive haematemesis

2021 ◽  
Author(s):  
S Kumar ◽  
A Kumar ◽  
M Dayal ◽  
V Prakash
Keyword(s):  
Laparoscopic Resection ◽  
Outlet Obstruction ◽  
Haemodynamic Instability ◽  
Contrast Enhanced ◽  
Submucosal Lesions ◽  
Gi Bleed ◽  
Enhanced Computed Tomography ◽  
Gastric Lipoma ◽  
Contrast Enhanced Computed Tomography ◽  
Massive Haematemesis

Gastric lipomas are rare benign neoplasms of the stomach. These submucosal lesions and located mostly in the antral region of the stomach. Small lipomas are usually asymptomatic and are detected incidentally. When large, they may present with abdominal pain, gastrointestinal (GI) bleeding or gastric outlet obstruction. We hereby present a case of gastric lipoma in a 54-year-old man presenting with massive upper GI bleed and haemodynamic instability. The diagnosis was established with endoscopy and contrast-enhanced computed tomography of the abdomen. After resuscitation, the patient underwent laparoscopic resection of the antral lipoma.

scholarly journals Adrenal Angiomyolipoma with Gastric Outlet Obstruction

2017 ◽  
Vol 9 (3) ◽  
pp. 109-110 ◽  
Author(s):  
Richa Jaiman ◽  
Puneet K Srivastava
Keyword(s):  
Computed Tomography ◽  
Adrenal Gland ◽  
Gastric Outlet Obstruction ◽  
Adrenal Tumor ◽  
Outlet Obstruction ◽  
Epithelioid Cells ◽  
Pain Abdomen ◽  
Contrast Enhanced ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

ABSTRACT Angiomyolipoma is neoplasm that derives from perivascular epithelioid cells. It is a rare mesenchymal tumor, usually found in the kidney. Extrarenal angiomyolipoma is uncommon and the most common extrarenal site is the liver. Angiomyolipoma of adrenal is extremely rare, with only four cases reported in the literature. It usually presents as incidentaloma. We report a case of a 45-year-old female patient presenting with pain abdomen, nausea, and repeated episodes of vomiting. Contrast-enhanced computed tomography (CECT) abdomen revealed heterogeneous nonenhancing hypodense fatty lesion in right adrenal gland. Biochemical investigations were negative for functioning adrenal tumor. Right adrenalectomy was done with good outcome. Diagnosis was confirmed by histopathology. The patient recovered without any complications following surgery. How to cite this article Srivastava PK, Jaiman R. Adrenal Angiomyolipoma with Gastric Outlet Obstruction. World J Endoc Surg 2017;9(3):109-110.

scholarly journals Hybrid surgery for a severe infectious innominate artery pseudoaneurysm compressing the main trachea

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052096584
Author(s):  
Li-Shan Lian ◽  
Zhe Zhang ◽  
Hai Feng ◽  
Xue-Ming Chen
Keyword(s):  
Saphenous Vein Graft ◽  
Innominate Artery ◽  
Covered Stent ◽  
Massive Hemorrhage ◽  
Hybrid Surgery ◽  
Artery Pseudoaneurysm ◽  
Contrast Enhanced ◽  
The Right ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Here, we report a case of an infectious pseudoaneurysm at the root of the innominate artery, compressing the trachea, that resulted in massive hemorrhage due to rupture of the innominate artery. The patient, a 31-year-old man, had complained of persistent fever for 40 days and severe dyspnea for 1 week. Contrast-enhanced computed tomography imaging of neck and thorax showed a pseudoaneurysm originating from the root of the innominate artery that was severely compressing the main trachea. A hybrid surgery strategy was applied. We first implanted a covered stent in the root of the innominate artery. Then, we performed a left-to-right carotid−carotid bypass with a great saphenous vein graft. Finally, we performed a median thoracotomy in which both the pseudoaneurysm and the previously implanted covered stent were successfully extracted. The patient lost strength in the right upper limb muscle on postoperative day 2 but recovered to baseline strength after 3 months. A hybrid surgical technique may represent a practical solution for such conditions.

Radiological Findings in Biliary Fistula and Gallstone Ileus

1996 ◽  
Vol 37 (3P2) ◽  
pp. 917-922 ◽  
Author(s):  
H. Oikarinen ◽  
M. Päivänsalo ◽  
T. Tikkakoski ◽  
A. Saarela
Keyword(s):  
Gallstone Ileus ◽  
Correct Diagnosis ◽  
Outlet Obstruction ◽  
Hepatic Cyst ◽  
Biliary Fistula ◽  
Imaging Findings ◽  
Radiological Findings ◽  
Bouveret’S Syndrome ◽  
Bile Ascites ◽  
Bouveret's Syndrome

Purpose: Biliary fistula and gallstone ileus are rarely found. The diagnosis is difficult and may be delayed until operation. We reviewed the radiological findings in a retrospective material. Material and Methods: The cases of 16 patients treated for biliary fistula were analyzed with respect to findings at imaging. Ten patients had a spontaneous fistula. Nine of them had an internal bilioduodenal fistula and one had an external fistula with stones passing through a subcutaneous abscess. Five patients also had gallstone ileus and one patient a rare gastric outlet obstruction caused by a gallstone (Bouveret's syndrome). Six patients had an iatrogenic fistula. One of them had internal bile ascites and 5 an external fistula, one of which was a biliocystic fistula resulting from attempted hepatic cyst sclerotherapy. Results: Various imaging modalities were used and there was often a delay in the diagnosis. Imaging did not show the fistula itself in any of the spontaneous cases. However, a nonvisualized or shrunken gallbladder seen at US often coexisted in these cases. CT yielded the diagnosis in one case of gallstone ileus, and a Gastrografin meal yielded it in the case of Bouveret's syndrome. Fistulography and cholangiography provided a correct diagnosis of fistula in all cases of iatrogenic biliocutaneous fistulas. Conclusion: Patients with biliary fistula usually undergo examinations with nonspecific results. The imaging findings could be more specific if the possibility of this diagnosis were remembered.

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