S2503 The Tale of Two Fistulas: A Comparison of Bouveret’s Syndrome Manifesting as a Cholecystogastric and Cholecystoduodenal Fistula

Bouveret's syndrome is defined as gastric outlet obstruction caused by duodenal impaction of a large gallstone which passes into the duodenal bulb through a cholecystogastric or cholecystoduodenal fistula. Initial attempts at endoscopic retrieval with or without mechanical or extracorporeal lithotripsy should be performed as first-line treatment, though success rates with endoscopic treatment are variable. We describe a case of Bouveret's Syndrome in an elderly patient that was successfully treated with endoscopic extraction combined with mechanical lithotripsy, and review the literature on this uncommon condition.

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Bouveret's Syndrome: A Rare Consequence of Malignant Cholecystoduodenal Fistula

Military Medicine ◽

10.1093/milmed/159.12.755 ◽

1994 ◽

Vol 159 (12) ◽

pp. 755-757 ◽

Cited By ~ 6

Author(s):

Tzvetan Antonov Panov ◽

Kirien Tzvetanov Kiossev ◽

Julian Emilov Losanoff

Keyword(s):

Cholecystoduodenal Fistula ◽

Bouveret’S Syndrome ◽

Bouveret's Syndrome

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

Acta Médica Portuguesa ◽

10.20344/amp.11664 ◽

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.

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Surgical Strategy in Bouveret's Syndrome. A Case Report

Acta Medica Marisiensis ◽

10.1515/amma-2016-0017 ◽

2016 ◽

Vol 62 (2) ◽

pp. 272-275

Author(s):

Márton István Dénes ◽

Árpád Török ◽

Etele Éltes ◽

Levente Kucserik ◽

Zsolt András ◽

...

Keyword(s):

Gallstone Ileus ◽

Good Condition ◽

High Morbidity ◽

Cholecystoduodenal Fistula ◽

Bouveret’S Syndrome ◽

Gastric Stasis ◽

Presenting Symptoms ◽

One Stage ◽

Postoperative Intensive Care ◽

Bouveret's Syndrome

AbstractBouveret's syndrome is a high mechanical obstruction due to impaction of a gallstone into the duodenum, through a cholecystoduodenal fistula. It belongs to a larger group of gallstone ileus, a disease which occurs after developing a fistula between the gallbladder and the gastrointestinal tract. This is a rare complication of gallstones but because it appears in elderly people, it has a high morbidity and mortality. Patients have various symptoms and the treatment is individualized. We present here a case of a 67 years old patient, admitted in emergency, presenting symptoms of high bowel obstruction, with onset 5 days before admission. Abdominal ultrasound reveals a 5 cm stone that seems to be in the gallbladder, gastric stasis and at gastroscopy appears a foreign body impacted in the duodenum. After a short preparation the patient underwent surgery. We found a dilated stomach and a large cholecystoduodenal fistula with an impacted gallstone in the duodenum. We performed one stage surgery: cholecystectomy, extraction of the stone and suturing of the fistula. We reestablished the continuity of the intestinal tract. We performed also an ileostomy for feeding the patient and protecting the anastomoses. The postoperative evolution was favorable.We consider that one stage surgical treatment in gallstone ileus is an option, if the patient is in good condition and we have an adequate postoperative intensive care management.

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Bouveret’s Syndrome: 64-Slice CT Diagnosis and Surgical Management—A Case Report

Case Reports in Radiology ◽

10.1155/2012/701216 ◽

2012 ◽

Vol 2012 ◽

pp. 1-4

Author(s):

Dinesh Sharma ◽

Rajan Sood ◽

Ashwani Tomar ◽

Anupam Jhobta ◽

Shruti Thakur ◽

...

Keyword(s):

Computed Tomography ◽

Surgical Management ◽

Duodenal Obstruction ◽

Outlet Obstruction ◽

Ct Diagnosis ◽

Cholecystoduodenal Fistula ◽

Bouveret’S Syndrome ◽

Elderly Female ◽

Bouveret's Syndrome ◽

Mdct Scanner

Gastric outlet obstruction caused by duodenal impaction of a large gallstone migrated through a cholecystoduodenal fistula has been referred to as Bouveret’s syndrome. We present a case of gallstone-induced duodenal obstruction in an elderly female patient, diagnosed on a 64-slice MDCT scanner. One-stage surgery, that is, stone removal and cholecystectomy, was performed resulting in relief of obstruction and complete cure. Clinical features, multidetector computed tomography (MDCT) findings, and surgical management are discussed.

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Laparoscopic Management of Bouveret’s Syndrome after Failed Endoscopic Approach

Case Reports in Surgery ◽

10.1155/2019/7067240 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Ariel Nicolas Tchercansky ◽

Guido Luis Busnelli ◽

Matías Mihura ◽

Rafael José Maurette

Keyword(s):

Laparoscopic Surgery ◽

Outlet Obstruction ◽

Enteric Fistula ◽

Endoscopic Removal ◽

Cholecystoduodenal Fistula ◽

Bouveret’S Syndrome ◽

Rare Presentation ◽

Unsuccessful Attempt ◽

Biliary Enteric Fistula ◽

Bouveret's Syndrome

Bouveret’s syndrome is a complication of cholelithiasis that presents with gastric outlet obstruction due to an impacted gallstone in the duodenum following cholecystoduodenal fistula. This is a rare presentation of biliary-enteric fistula; therefore, there are no standardized guidelines for the management of this disease. We present a case of a patient with Bouveret’s syndrome managed with laparoscopic surgery after an unsuccessful attempt of endoscopic removal.

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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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