831 Bouveret’s Syndrome (A Gallstone Disease Causing Gastric Outlet Obstruction): A Case Series and Review of Literature

Bouveret’s syndrome refers to a gastric outlet obstruction due to the impaction of a large gallstone following retrograde migration via a bilio-duodenal fistula. Although no clear management guideline has been formulated, different treatment modalities have been described, including endoscopic stone removal using classical endoscopic devices, like snares and forceps; or fragmentation of stones with new devices, such as laser and extracorporeal shockwave lithotripsy (EWSL). We report a case series of Bouveret’s syndrome with interesting radiological and endoscopic findings which have been successfully managed either via endoscopic measures such as stone extraction and/or duodenal stenting, or surgical intervention. The report is followed by a literature review including diagnostic and management options of this rare condition. All our patients were elderly with multiple comorbidities. Two patients presented with upper gastro-intestinal bleeding, while the other two presented with abdominal pain and bilious vomiting. The diagnosis was confirmed by computerised tomography (CT) scan and upper gastro-intestinal endoscopy. Endoscopic stone removal was successful in one case. In one patient, stone was fragmented but could not be removed completely, so he was managed via duodenal stent insertion. The other two patients required surgical intervention. One case was complicated by gallstone ileus which required laparotomy and extraction of stones from two sites, while the other required subtotal cholecystectomy, stone extraction and repair of duodenal fistula. The patients recovered well. The diagnosis of Bouveret’s Syndrome is made after performing appropriate imaging studies. The first line management option is endoscopic treatment. If this fails, surgical intervention is recommended.

Bouveret's syndrome, an unusual cause of duodenal obstruction.

Resumen El síndrome de Bouveret constituye la variedad más infrecuente de íleo biliar y se describe en la literatura médica como una entidad poco común. Las manifestaciones clínicas son muy inespecíficas y el diagnóstico puede ser tanto endoscópico como radiológico para detectar el cuadro de obstrucción intestinal de forma precoz y ser lo más conservadores posibles, siendo de elección la extracción endoscópica y si ésta fracasa la cirugía. A pesar de todo, la mortalidad en estos pacientes suele ser elevada ya que afecta preferentemente a pacientes ancianos con numerosas comorbilidades, de ahí que consideremos imperativo intentar solucionar el problema mediante técnicas menos agresivas. Presentamos el caso de una paciente de reciente diagnóstico en nuestro hospital, cuyo diagnóstico fue de manera urgente mediante un TC abdominopélvico y tratada mediante enterostomía y extracción del cálculo.