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Gómez Otero M, Valdivielso Cortázar E, Miñones Ginarte C, Madarnás Alonso L, Pérez Vior L, Couto Wörner I, Souto Ruzo J, Alonso Aguirre PA. Cholecystogastric fistula diagnosed by endoscopic ultrasonography. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:749-750. [PMID: 37771296 DOI: 10.17235/reed.2023.9915/2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
A case of a patient with symptoms of gastric obstruction secondary to cholecystogastric fistula is presented and a brief review of the literature is done.
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Affiliation(s)
| | | | | | | | - Lucía Pérez Vior
- Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña
| | | | - José Souto Ruzo
- Aparato Digestivo, Complejo Hospitalario Universitario de A Coruña
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2
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Satchithanandha V, Lau NS, Galevska A, Sandroussi C. Bouveret syndrome: two approaches one stone. J Surg Case Rep 2023; 2023:rjad570. [PMID: 37854526 PMCID: PMC10581706 DOI: 10.1093/jscr/rjad570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/21/2023] [Indexed: 10/20/2023] Open
Abstract
Bouveret syndrome is a rare cause of gastric outlet obstruction, a consequence of a large impacted gallstone leading to the formation of a bilioenteric fistula. We present a case of a 79-year-old female who presented with a history of persistent nausea and vomiting. Computed tomography of the abdomen revealed a large gallstone impacted in the second part of the duodenum, complicated by a cholecystoduodenal fistula, leading to gastric outlet obstruction. After nasogastric decompression, the patient underwent an upper gastrointestinal endoscopy and attempted stone retrieval which was unsuccessful. Consequently, she underwent laparotomy, gastrotomy, and extraction of the stone. This case highlights the pitfalls of managing Bouveret syndrome via an endoscopic or an open surgical approach.
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Affiliation(s)
| | - Ngee-Soon Lau
- Royal Prince Alfred Hospital, 50, Missendon Road, Camperdown, NSW 2050, Australia
| | - Ana Galevska
- Royal Prince Alfred Hospital, 50, Missendon Road, Camperdown, NSW 2050, Australia
| | - Charbel Sandroussi
- Royal Prince Alfred Hospital, 50, Missendon Road, Camperdown, NSW 2050, Australia
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3
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Wang H, Blackmore C, Bonnichsen M, Ermerak G, Bassan M. Endoscopic Management of Bouveret Syndrome With Electrohydraulic Lithotripsy. ACG Case Rep J 2023; 10:e01051. [PMID: 37705965 PMCID: PMC10497240 DOI: 10.14309/crj.0000000000001051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/07/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Hunter Wang
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney, Australia
- Department of Gastroenterology and Hepatology, Sydney Adventist Hosptial, Australia
| | - Conner Blackmore
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney, Australia
- University of New South Wales, South Western Sydney Clinical School, Sydney, Australia
| | - Mark Bonnichsen
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney, Australia
| | - George Ermerak
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney, Australia
| | - Milan Bassan
- Department of Gastroenterology and Hepatology, Liverpool Hospital, Sydney, Australia
- University of New South Wales, South Western Sydney Clinical School, Sydney, Australia
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4
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Kulkarni DR, Goradia PP, Kulkarni ND, Garge S. Multiple Cholecystoenteric Fistulae With Bouveret Syndrome and Acute Pancreatitis: A Rare Combination. Cureus 2023; 15:e38152. [PMID: 37252554 PMCID: PMC10216002 DOI: 10.7759/cureus.38152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Multiple cholecystoenteric fistulae, Bouveret syndrome (a form of gallstone ileus), and acute pancreatitis occurring together is very rare. Diagnosis is seldom clinical and is mostly based on computerised tomography (CT) or magnetic resonance imaging (MRI). Endoscopy and minimally invasive surgery have revolutionised the treatment of Bouveret syndrome and cholecystoenteric fistula, respectively, over the last two decades. Laparoscopic repair of cholecystoenteric fistula followed by cholecystectomy is successful on a consistent basis with skilled laparoscopic suturing and advanced laparoscopy. In patients with Bouveret syndrome, when the stone is <4cm and is in the proximal duodenum, it is usually amenable for endoscopic extraction with snares, nets, forceps and lithotripsy. When endoscopy is unavailable or fails, laparoscopic surgery is suitable for these patients. However, stones >4 cm, located in the distal duodenum, multiple fistulae, and associated acute pancreatitis may necessitate open surgery. We present here a case of a 65-year-old Indian female with multiple cholecystoenteric fistulae and Bouveret syndrome with acute pancreatitis with a 6.5 cm gallstone diagnosed on CT scan and MRI and treated successfully by open surgery. We also review the current literature on the management of this complex problem.
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Affiliation(s)
| | - Pooja P Goradia
- Gastrointestinal Surgery, Liver & Pancreas Clinic, Mumbai, IND
| | - Neha D Kulkarni
- Medicine, K. J. (Karamshi Jethabhai) Somaiya Medical College, Mumbai, IND
| | - Shrikant Garge
- Gastrointestinal Surgery, Liver & Pancreas Clinic, Mumbai, IND
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Jaroenlapnopparat A, Demirjian AN, Brugge WR, Kher KR. A Case of Bouveret's Syndrome Treated With Holmium:Yttrium-Aluminum-Garnet Laser. Cureus 2023; 15:e37258. [PMID: 37162779 PMCID: PMC10164363 DOI: 10.7759/cureus.37258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2023] [Indexed: 05/11/2023] Open
Abstract
Bouveret's syndrome is a rare form of gallstone ileus described as a gastric outlet obstruction from a gallstone that travels from the gallbladder to the bowel through a bilioenteric fistula. Despite its rarity, the mortality rate of this condition is high. Endoscopic treatment is preferred over surgery due to the association with lower mortality rate. To date, there are limited data about the application of holmium:yttrium-aluminum-garnet (YAG) laser lithotripsy for fragmentation of gallstones in Bouveret's syndrome. We present the case of a 74-year-old man with multiple cardiac comorbidities who presented with periumbilical pain, decreased appetite, and vomiting. The patient had previously been admitted three months prior with acute cholecystitis, and a cholecystostomy tube was placed. He had leukocytosis and purulent discharge in his cholecystostomy bag. Computed tomography (CT) scan of the abdomen and pelvis showed a change in the position of a previously seen large gallstone from the neck of the gallbladder on the last admission, to the lumen of the duodenal bulb on this admission. This indicated the development of a cholecystoduodenal fistula, with the stone passing through this fistula into the duodenal bulb, causing the complete obstruction. Endoscopic treatment was recommended by the surgery team due to cardiac comorbidities and the significant friability of the tissue requiring laparotomy. Initial endoscopic evaluation showed complete obstruction of the duodenal bulb by a large smooth stone, not allowing passage of a guidewire beyond the stone. Therefore, holmium:YAG laser lithotripsy was used. After two sessions of laser therapy, four days apart, each breaking a pigmented and calcified stone, it eventually passed through the small bowel into the colon, relieving the obstruction. The patient had a favorable outcome and did not require surgery. This case report shows that holmium:YAG laser lithotripsy is capable of delivering favorable outcomes, as seen in a patient with a heavily calcified and pigmented stone, older age, and multiple comorbidities. Holmium:YAG laser could be considered for use with endoscopic equipment for future management of this condition, especially in patients who have medical comorbidities and heavily calcified gallstones.
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Affiliation(s)
| | - Aram N Demirjian
- Surgery, Mount Auburn Hospital, Harvard Medical School, Cambridge, USA
| | - William R Brugge
- Gastroenterology, Mount Auburn Hospital, Harvard Medical School, Cambridge, USA
| | - Kinnari R Kher
- Gastroenterology, Mount Auburn Hospital, Harvard Medical School, Cambridge, USA
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6
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Pinheiro JL, Logrado A, Aveiro D, Ferreira MJ, Pereira J. Synchronous Gallstone Ileus and Bouveret’s Syndrome: A Report of Two Rare Concurrent Complications of Gallstone Disease. Cureus 2023; 15:e35672. [PMID: 37012966 PMCID: PMC10066062 DOI: 10.7759/cureus.35672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Cholecystoenteric fistulas occur as a result of a chronic inflammatory insult involving the gallbladder and the erosion of both its wall and a bowel segment. When the fistula develops, it creates a pathway for gallstones to migrate and cause an intestinal obstruction, known as gallstone ileus. When it obstructs the gastric outlet, a proximal variant of gallstone ileus occurs, known as Bouveret's syndrome. A 65-year-old man presented to the emergency department with a three-day history of epigastric and right upper quadrant pain and persistent vomiting, preceded by unintentional weight loss of 15 kg over three months. Endoscopic and complementary imaging studies identified a concurrent gastric outlet obstruction caused by a lodged gallstone in the duodenal bulb and gallstone ileus. The patient underwent an urgent exploratory laparotomy and was submitted to an enterolithotomy and gastrolithotomy. Due to a sudden deterioration on the fourth postoperative day, he underwent an emergent re-laparotomy that found fecal peritonitis and complete dehiscence of both closures. The patient was then managed with damage control surgery. An atypical gastric resection and enterectomy of the distal ileum were performed and the patient was admitted to the intensive care unit in temporary abdominal closure (laparostomy). The patient failed to improve and died on the same day. Ultimately, the patient's multiple comorbidities, including morbid obesity, malnutrition, and diabetes, contributed to poor tissue healing and the fatal outcome. Gallstone ileus and Bouveret's syndrome are two rare complications of cholecystoduodenal fistulas that have not yet been reported to occur simultaneously. Both intestinal and gastric obstruction makes the surgical approach the first-line treatment.
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Dixon A, Williams MD, Makiewicz K, Khokar A, Bonomo S. Two unique cases of Bouveret syndrome with review of literature. J Surg Case Rep 2022; 2022:rjac379. [PMID: 36003224 PMCID: PMC9393188 DOI: 10.1093/jscr/rjac379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 07/30/2022] [Indexed: 12/01/2022] Open
Abstract
Bouveret syndrome is a rare form of gallstone ileus in which a proximally lodged gallstone in the duodenum causes a gastric outlet obstruction. It is a rare condition that can be challenging to manage. Although endoscopic management remains first line, a surgical approach can be needed. We present two cases of Bouveret syndrome. A 65-year-old man with oral squamous cell carcinoma treated with endoscopic management and a 63-year-old woman treated with surgery.
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Affiliation(s)
- Austin Dixon
- Department of Surgery, Midwestern University (Chicago College of Osteopathic Medicine) , Chicago, IL , USA
| | - Michael D Williams
- Department of General Surgery, Rush University Medical Center , Chicago, IL , USA
| | - Kristine Makiewicz
- Department of General Surgery, Cook County Health (John H. Stroger Hospital) , Chicago, IL , USA
| | - Amna Khokar
- Department of General Surgery, Cook County Health (John H. Stroger Hospital) , Chicago, IL , USA
| | - Steven Bonomo
- Department of General Surgery, Cook County Health (John H. Stroger Hospital) , Chicago, IL , USA
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8
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Parvataneni S, Khara HS, Diehl DL. Bouveret syndrome masquerading as a gastric mass-unmasked with endoscopic luminal laser lithotripsy: A case report. World J Clin Cases 2020; 8:5701-5706. [PMID: 33344563 PMCID: PMC7716301 DOI: 10.12998/wjcc.v8.i22.5701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/08/2020] [Accepted: 10/26/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Bouveret syndrome, also known as gallstone ileus, is a rare form of gastric outlet obstruction accounting for 1%-3% of cases. This condition is most often reported in females. The diagnosis can be challenging and is often missed due to atypical presentations, which occasionally mimic gastric outlet obstruction symptoms such as nausea, vomiting, loss of appetite and hematemesis. The symptoms vary with stone size. Larger stones are managed with a surgical approach, but this carries increased morbidity and mortality. Over the past decade, the endoscopic approach has emerged as an alternative mode of treatment, but it is generally unsuccessful in the management of larger-sized stones. A literature review revealed cases of successful endoscopic treatment requiring multiple sessions for stone sizes measuring up to about 4.5 cm. Here we present a unique case of an elderly patient with Bouveret syndrome with a 5 cm stone mimicking a gastric mass and causing gastric outlet obstruction, who was successfully managed in a single session using a complete endoscopic approach with laser lithotripsy.
CASE SUMMARY An 85-year-old female patient presented with 1-month history of intermittent abdominal pain, vomiting, decreased appetite and weight loss. An abdominal computed tomography showed a 4.5 cm × 4.7 cm partially calcified mass at the gastric pylorus causing gastric outlet obstruction. Endoscopy showed an ulcerated fistulous opening and a large 5 cm impacted gallstone in the duodenal bulb. Endoscopic nets and baskets were used in an attempt to remove the stone, but this approach was unsuccessful. Given her advanced age, poor physical condition and underlying comorbidities, she was deemed to be high-risk for surgery. Thus, a minimally invasive approach using endoscopic laser lithotripsy was attempted and successfully treated the stone. Post-procedure, the patient experienced complete resolution of her symptoms with no complications and was able to tolerate her diet. She was subsequently discharged home at 48 h, with an uneventful recovery.
CONCLUSION In our paper we describe Bouveret syndrome and highlight its management with a novel endoscopic approach of laser lithotripsy in addition to various other endoscopic approaches available to date and its success rates.
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Affiliation(s)
- Swetha Parvataneni
- Department of Internal Medicine, Geisinger Lewistown Hospital, Lewistown, PA 17044, United States
| | - Harshit S Khara
- Department of Gastroenterology and Hepatology, Advanced Endoscopy, Geisinger Health system, Danville, PA 17822, United States
| | - David L Diehl
- Department of Gastroenterology and Nutrition, Geisinger Medical Center, Danville, PA 17822, United States
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9
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Sun HW, Yan HF, Sun PM, Cui Y. Focus on management of gallstone ileus. Shijie Huaren Xiaohua Zazhi 2020; 28:1004-1008. [DOI: 10.11569/wcjd.v28.i20.1004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gallstone ileus is a rare form of intestinal obstruction and an uncommon complication of gallstone disease resulting from the impaction of one or more gallstones in the bowel owing to biliary intestinal fistula. The increasing incidence of gallstone ileus is related to the high prevalence of cholelithiasis, the aging of the population, and the more sensitive diagnostic tools. The diagnosis is often delayed due to the lack of typical clinical manifestations. In this paper, we discuss the pathogenesis of gallstone ileus, factors that result in its diagnosis, and therapeutic strategies by performing a systematic review of the literature. We also emphasize the specificity and complexity of gallstone ileus. We suggest that on the basis of observing the basic principles, the management should be rationalized and individualized in clinical practice so as to improve the prognosis of gallstone ileus.
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Affiliation(s)
- Hong-Wei Sun
- Department of General Surgery, Characteristic Medical Center of Chinese People's Liberation Army Strategic Support Force, Beijing 100101, China
| | - Hong-Feng Yan
- Department of General Surgery, Characteristic Medical Center of Chinese People's Liberation Army Strategic Support Force, Beijing 100101, China
| | - Pei-Ming Sun
- Department of General Surgery, Characteristic Medical Center of Chinese People's Liberation Army Strategic Support Force, Beijing 100101, China
| | - Yan Cui
- Department of General Surgery, Characteristic Medical Center of Chinese People's Liberation Army Strategic Support Force, Beijing 100101, China
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10
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Hendriks S, Verseveld MM, Boevé ER, Roomer R. Successful endoscopic treatment of a large impacted gallstone in the duodenum using laser lithotripsy, Bouveret’s syndrome: A case report. World J Gastroenterol 2020; 26:2458-2463. [PMID: 32476805 PMCID: PMC7243648 DOI: 10.3748/wjg.v26.i19.2458] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 04/03/2020] [Accepted: 04/26/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Bouveret´s syndrome is defined as a gastric outlet obstruction after passage of a gallstone through a fistula into the duodenum. Due to its rarity, the diagnosis of Bouveret’s syndrome is often delayed and causes a high morbidity and mortality rate.
CASE SUMMARY A 93-year-old female presented with worsening pain in the right upper abdomen and vomiting. A gastroscopy revealed fluid retention caused by a massive obstructive stone in the bulbus. Endoscopic laser lithotripsy of the impacted stone was planned after multidisciplinary consultation. A Dornier Medilas H Solvo lithotripsy 350 µm laser fiber (10 Hz, 2 Joules) was used to disintegrate the stone into smaller pieces. The patient recovered completely.
CONCLUSION A mechanical obstruction due to a gallstone that has entered the gastrointestinal tract is a complication that appears in 0.3%-0.5% of patients who have cholelithiasis. Stones larger than 2 cm can become impacted in the digestive tract, which occurs mostly in the terminal ileum. In approximately 1%-3% of cases, the stones cause obstruction in the duodenum. This phenomenon is called Bouveret’s syndrome. As this condition is mostly observed in elderly individuals with multiple comorbidities, treatment by an open surgical approach is unsuitable. Endoscopic removal is the preferred technique. The benefit of using laser lithotripsy is the precise targeting of energy onto the stone with minimal tissue injury. Endoscopic laser lithotripsy is a safe and feasible treatment option for Bouveret’s syndrome.
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Affiliation(s)
- Sofie Hendriks
- Department of Gastroenterology, Franciscus Gasthuis & Vlietland, Rotterdam 3045 PM, Zuid-Holland, Netherlands
| | - Mareille Maria Verseveld
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam 3045 PM, Zuid-Holland, Netherlands
| | - Egbert Roeland Boevé
- Department of Urology, Franciscus Gasthuis & Vlietland, Rotterdam 3045 PM, Zuid-Holland, Netherlands
| | - Robert Roomer
- Department of Gastroenterology, Franciscus Gasthuis & Vlietland, Rotterdam 3045 PM, Zuid-Holland, Netherlands
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11
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Rafael MA, Figueiredo L, Horta D, Martins A. Treatment of Bouveret Syndrome with Electrohydraulic Lithotripsy. Clin Endosc 2020; 53:241-242. [PMID: 31722519 PMCID: PMC7137574 DOI: 10.5946/ce.2019.193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 09/26/2019] [Indexed: 01/02/2023] Open
Affiliation(s)
- Maria-Ana Rafael
- Department of Gastroenterology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Luísa Figueiredo
- Department of Gastroenterology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - David Horta
- Department of Gastroenterology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Alexandra Martins
- Department of Gastroenterology, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
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12
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Abstract
Background Gallstone ileus is an important complication of cholecystolithiasis. In general, surgery is the treatment of choice for such cases, but clinicians face difficulty in the selection of an appropriate approach. Closure of a cholecystoenteric fistula can be achieved through one-stage or two-stage operation. Two-stage operation has a lower mortality rate than a one-stage procedure, but persistence of the cholecystoenteric fistula is associated with the risk of carcinogenesis and recurrence of gallstone ileus. Objective This study reviews the different surgical approaches according to the impaction site of the gallstone, using data of previous studies by our group and clinical reports in the literature. Conclusions First, for cases involving impaction at the duodenum, the cholecystoenteric fistula can be repaired in the same surgical field, and one-stage operation obtains favourable outcome; hence, one-stage operation is considered as treatment of choice. Second, for cases involving impaction at the small intestine, natural closure of the cholecystoenteric fistula or low mortality is expected; hence, two-stage operation may be performed, possibly using minimally invasive laparoscopy. Third, for cases involving impaction at the colon, natural closure of the cholecystocolonic fistula is unlikely, and patients have a high risk of reflux cholangitis due to faecal fluid; hence, one-stage operation is considered as treatment of choice.
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Affiliation(s)
- Koichi Inukai
- Department of Acute Care Surgery, Sakai City Medical Center, Sakai, Osaka, Japan
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13
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Futai R, Iemoto T, Inoue Y, Miki M, Abe T, Abe S, Sasaki A, Tanaka K, Yoshie T, Ose T, Morikawa T, Sanuki T. Successful Treatment of Bouveret Syndrome by Electrohydraulic Lithotripsy and Double Balloon Endoscopy. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1320-1324. [PMID: 31488806 PMCID: PMC6753665 DOI: 10.12659/ajcr.917964] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Patient: Female, 84 Final Diagnosis: Bouveret syndrome Symptoms: Abdominal and/or epigastric pain vomitting Medication: — Clinical Procedure: Electrohydraulic lithotripsy Specialty: Gastroenterology and Hepatology
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Affiliation(s)
- Ryoko Futai
- Department of Gastroenterology, Kita-Harima Medical Center, Ono, Hyogo, Japan
| | - Takao Iemoto
- Department of Gastroenterology, Kita-Harima Medical Center, Ono, Hyogo, Japan
| | - Yuta Inoue
- Department of Gastroenterology, Kita-Harima Medical Center, Ono, Hyogo, Japan
| | - Mika Miki
- Department of Gastroenterology, Kita-Harima Medical Center, Ono, Hyogo, Japan
| | - Tetsuyuki Abe
- Department of Gastroenterology, Kita-Harima Medical Center, Ono, Hyogo, Japan
| | - Shohei Abe
- Department of Gastroenterology, Kita-Harima Medical Center, Ono, Hyogo, Japan
| | - Ayaka Sasaki
- Department of Gastroenterology, Kita-Harima Medical Center, Ono, Hyogo, Japan
| | - Katsuhide Tanaka
- Department of Gastroenterology, Kita-Harima Medical Center, Ono, Hyogo, Japan
| | - Tomoo Yoshie
- Department of Gastroenterology, Kita-Harima Medical Center, Ono, Hyogo, Japan
| | - Takayuki Ose
- Department of Gastroenterology, Kita-Harima Medical Center, Ono, Hyogo, Japan
| | - Teruhisa Morikawa
- Department of Gastroenterology, Kita-Harima Medical Center, Ono, Hyogo, Japan
| | - Tsuyoshi Sanuki
- Department of Gastroenterology, Kita-Harima Medical Center, Ono, Hyogo, Japan
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14
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Abdallah MA, Atiq M, Kushnir V, Das KK, Doyle MB, Chapman WC, Khan AS. Management of Bouveret's syndrome. J Dig Dis 2019; 20:215-219. [PMID: 30756478 DOI: 10.1111/1751-2980.12713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 01/23/2019] [Accepted: 02/11/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Mohamed A Abdallah
- Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Muslim Atiq
- Department of Gastroenterology, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, USA
| | - Vladimir Kushnir
- Division of Gastroenterology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Koushik K Das
- Division of Gastroenterology, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Maria B Doyle
- Division of Transplant Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - William C Chapman
- Division of Transplant Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Adeel S Khan
- Division of Transplant Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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15
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Novel Use of an Endoscopic Suturing Device to Repair a Cholecystoduodenal Fistula. ACG Case Rep J 2017; 4:e121. [PMID: 29201932 PMCID: PMC5703761 DOI: 10.14309/crj.2017.121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/28/2017] [Indexed: 02/07/2023] Open
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16
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Kostakis ID, Garoufalia Z, Feretis T, Kykalos S, Mantas D. A case of Bouveret's syndrome treated with gastrojejunal anastomosis. J Surg Case Rep 2017; 2017:rjx213. [PMID: 29423151 PMCID: PMC5798125 DOI: 10.1093/jscr/rjx213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/22/2017] [Accepted: 09/30/2017] [Indexed: 12/30/2022] Open
Abstract
Bouveret's syndrome is a rare cause of proximal gallstone ileus with obstruction of duodenum or gastric outlet. We report a case of an 87-year-old female patient presented with 1 week history of vomiting whose plain radiograms showed ileus and pneumobilia. The abdominal computed tomography confirmed pneumobilia and revealed free air and leakage of oral contrast agent in the hepatic hilum and subhepatic space and an impacted gallstone in the third portion of the duodenum. The patient underwent exploratory laparotomy, which showed that the duodenal perforation was circumvallated, and a side-to-side retrocolic gastrojejunal anastomosis was performed in order to surpass the impacted gallstone. Removal of the impacted gallstone through enterotomy or gastrotomy or endoscopic lithotripsy is the usual treatment of Bouveret's syndrome. However, gastrojejunal bypass may be a treatment option when the patient undergoes laparotomy and the gallstone is impacted in the third or fourth portion of the duodenum.
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Affiliation(s)
- Ioannis D Kostakis
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
| | - Zoe Garoufalia
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
| | - Themistoklis Feretis
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
| | - Stylianos Kykalos
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
| | - Dimitrios Mantas
- Second Department of Propedeutic Surgery, National and Kapodistrian University of Athens, Medical School, 'Laiko' General Hospital, Athens, Greece
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Banu P, Constantin VD, Popa F, Nistor MF, Motofei IG, Bălălău C. Gallstone ileus - the double challenge: case report and review of the literature. JOURNAL OF CLINICAL AND INVESTIGATIVE SURGERY 2016. [DOI: 10.25083/2559.5555.11.1521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Gallstone ileus is a rare condition which occurs as an evolutive complication of biliary lithiasis. It occurs after stone migration from extrahepatic biliary tree to the digestive lumen, mostly through a biliary-enteric fistula. This condition involves repeated inflammatory relapses with the formation of local adhesions and generally requires a long evolution. The vast majority of patients with biliary ileus are third aged women who often have concomitant medical illnesses. Gallstone ileus surgery deals with the two components: bowel obstruction and biliary pole. Obstruction solving is approached as a surgical emergency and it requires an attitude adapted to the local situation. The attitude towards biliary surgery for gallstone ileus is a matter in debate. It could be one-stage surgery, elective surgery or expectancy and its choice is imposed by both local and general condition of the patient. We report the case of a middle-age woman whose first symptom of cholelithiasis was the gallstone ileus. Plain upright abdominal radiography revealed air-fluid levels with distended loops of the small bowel and pneumobilia. Laparotomy was decided and exploration revealed an impacted gallstone into the ileum and dense adhesions were found under the liver region. Enterolithotomy for gallstone removal was made. Postoperative evolution was uneventful with discharge on 7th day.
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