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Ferhatoğlu MF, Kartal A. Bouveret's Syndrome: A Case-Based Review, Clinical Presentation, Diagnostics and Treatment Approaches. Sisli Etfal Hastan Tip Bul 2020; 54:1-7. [PMID: 32377127 DOI: 10.14744/SEMB.2018.03779] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 07/18/2018] [Indexed: 12/22/2022]
Abstract
Gastric outlet obstruction that arises from gallstones impacted in the distal stomach or proximal duodenum after passing through a cholecystoduodenal, cholecystogastric or rarely choledocoduodenal fistula is called as Bouveret’s syndrome and it accounts for approximately 1-3% of all the patients with gallstone ileus. Although treatment modalities, including stone removal or fragmentation with classical endoscopic devices, such as snares, and forceps or fragmentation of gallstones with new devices, such as electrohydraulic lithotripsy, laser, extracorporeal shockwave lithotripsy have been described. However, only 29% of the patients benefit from nonsurgical methods. Removal of the stone through a gastrotomy or enterotomy and performing cholecystectomy and fistula repair with a second operation is an approach recommended for older patients with comorbid diseases. In this paper, a case of Bouveret’s syndrome was presented. The authors also aimed to review the diagnosis, management and treatment of this rare disease and to update the previous reviews.
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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. Am J Case Rep 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Scuderi V, Adamo V, Naddeo M, Di Natale W, Boglione L, Cavalli S. Gallstone ileus: monocentric experience looking for the adequate approach. Updates Surg 2018; 70:503-11. [PMID: 29019098 DOI: 10.1007/s13304-017-0495-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 10/02/2017] [Indexed: 12/18/2022]
Abstract
Common complications of biliary lithiasis are cholecystitis, bile duct lithiasis, and acute biliary pancreatitis. Gallstone ileus is uncommon complications often requiring surgical approach. It is a mechanical bowel obstruction caused by a biliary calculus usually originating from a bilioenteric fistula. Because of the limited number of reported cases, the optimal surgical method of treatment has been the subject of ongoing debate. A retrospective, observational, descriptive study was conduct on patients diagnosed with non-neoplastic bowel occlusion. For each case of gallstone ileus, the following variables were revised: personal and clinical data, mean time of onset of symptoms, length of pre- and postoperative stay, imaging studies, biochemical tests, site of the bilioenteric fistula and occlusion, surgical strategy, postoperative course, follow-up, and mortality. Of the 290 cases of non-neoplastic bowel obstruction from 2008 to 2015, 11 (3.7%) were due to gallstone ileus. The majority of patients were elderly women (F 9/M 2) with high average age (82.4; 76-88) and significant comorbidities. Five cases of small-bowel occlusions were treated with solely enterolithotomy. For the remaining six cases, digestive resection and cholecystectomy were performed. Complications rate (20 vs. 80%) and postoperative stay (12.4 vs. 25.3 days) were lower in the group of enterolithotomy with respect to the group treated with other procedures. In-hospital mortality was nil. Gallstone ileus is an uncommon bowel occlusion affecting mainly the elderly female population. Enterotomy with stone extraction alone is associated with better outcomes than more invasive techniques.
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AL-Habbal Y, Ng M, Bird D, McQuillan T, AL-Khaffaf H. Uncommon presentation of a common disease - Bouveret's syndrome: A case report and systematic literature review. World J Gastrointest Surg 2017; 9:25-36. [PMID: 28138366 PMCID: PMC5237820 DOI: 10.4240/wjgs.v9.i1.25] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/30/2016] [Accepted: 12/07/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate and summarise the current evidence surrounding management of Bouveret's syndrome (BS). METHODS A MEDLINE search was performed for the BS. The search was conducted independently by two clinicians (Yahya AL-Habbal and Matthew Ng) in April 2016. A case of BS is also described. RESULTS A total of 315 articles, published from 1967 to 2016, were found. For a clinically meaningful clinical review, articles published before 01/01/1990 and were excluded, leaving 235 unique articles to review. Twenty-seven articles were not available (neither by direct communication nor through inter-library transfer). These were also excluded. The final number of articles reviewed was 208. There were 161 case reports, 13 reviews, 23 images (radiological and clinical images), and 11 letters to editor. Female to male ratio was 1.82. Mean age was 74 years. Treatment modalities included laparotomy in the majority of cases, laparoscopic surgery, endoscopic surgery and shockwave lithotripsy. CONCLUSION There is limited evidence in the literature about the appropriate approach. We suggest an algorithm for management of BS.
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Crespi M, Montecamozzo G, Foschi D. Diagnosis and Treatment of Biliary Fistulas in the Laparoscopic Era. Gastroenterol Res Pract. 2016;2016:6293538. [PMID: 26819608 PMCID: PMC4706943 DOI: 10.1155/2016/6293538] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 08/23/2015] [Indexed: 12/17/2022] Open
Abstract
Biliary fistulas are rare complications of gallstone. They can affect either the biliary or the gastrointestinal tract and are usually classified as primary or secondary. The primary fistulas are related to the biliary lithiasis, while the secondary ones are related to surgical complications. Laparoscopic surgery is a therapeutic option for the treatment of primary biliary fistulas. However, it could be the first responsible for the development of secondary biliary fistulas. An accurate preoperative diagnosis together with an experienced surgeon on the hepatobiliary surgery is necessary to deal with biliary fistulas. Cholecystectomy with a choledocoplasty is the most frequent treatment of primary fistulas, whereas the bile duct drainage or the endoscopic stenting is the best choice in case of minor iatrogenic bile duct injuries. Roux-en-Y hepaticojejunostomy is the extreme therapeutic option for both conditions. The sepsis, the level of the bile duct damage, and the involvement of the gastrointestinal tract increase the complexity of the operation and affect early and late results.
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Pezzoli A, Maimone A, Fusetti N, Pizzo E. Gallstone ileus treated with non-surgical conservative methods: a case report. J Med Case Rep 2015; 9:15. [PMID: 25971789 PMCID: PMC4429341 DOI: 10.1186/1752-1947-9-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/08/2014] [Indexed: 11/19/2022] Open
Abstract
Introduction The preoperative diagnosis of gallstone ileus is challenging due to the variability of its presentation, often resulting in late diagnosis. Controversy remains regarding the management of gallstone ileus; surgery is the standard treatment, but also less invasive approaches have proven to be successful. We present an unusual case of gallstone ileus and its conservative treatment. Case presentation We describe the case of a 49-year-old Caucasian woman with a bowel sub-occlusion, treated conservatively. The imaging technique (plain abdominal X-ray and computed tomography scan) led to a diagnosis of gallstones ileus. A surgical intervention was not performed. Instead, she underwent extracorporeal shock-wave lithotripsy to fragment the stones, mechanical intestinal dilatation for ileocolic stenosis and endoscopic removal of the gallstone. The presence of an apricot shell contributed to the bowel occlusion and was removed. The intervention was successful and without complications. Conclusions Given the variability of the gallstone ileus presentation, surgery could not be the only treatment for our patient. In our case report, we show that colonoscopy could be a non-invasive approach that allows for diagnosis and treatment at the same time. The available data do not show a higher rate of recurrent biliary disease in cases where this method has been used, therefore in select patients, a conservative treatment could be an effective solution.
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Affiliation(s)
- Alessandro Pezzoli
- Department of Gastroenterology and Endoscopy Unit, Sant'Anna University Hospital, v. A. Moro 8 203, 44124, Cona, Ferrara, Italy.
| | - Antonella Maimone
- Department of Gastroenterology and Endoscopy Unit, Sant'Anna University Hospital, v. A. Moro 8 203, 44124, Cona, Ferrara, Italy.
| | - Nadia Fusetti
- Department of Gastroenterology and Endoscopy Unit, Sant'Anna University Hospital, v. A. Moro 8 203, 44124, Cona, Ferrara, Italy.
| | - Elena Pizzo
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E7HB, UK.
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Abstract
Bouveret syndrome is an unusual complication of cholelithiasis which results in upper gastrointestinal obstruction due to a gallstone impacted in the duodenum through a bilio-enteric fistula. We present this rare entity which was primarily diagnosed on magnetic resonance (MR) and MR cholangiopancreaticography (MRCP) study.
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Affiliation(s)
- Rajkumar Singh Negi
- Department of Radiodiagnosis, Base Hospital, Delhi Cantonment, New Delhi, India
| | - Mukesh Chandra
- Department of Radiodiagnosis, Base Hospital, Delhi Cantonment, New Delhi, India
| | - Rajiv Kapur
- Department of Radiodiagnosis, Base Hospital, Delhi Cantonment, New Delhi, India
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Nickel F, Müller-Eschner MM, Chu J, von Tengg-Kobligk H, Müller-Stich BP. Bouveret's syndrome: presentation of two cases with review of the literature and development of a surgical treatment strategy. BMC Surg 2013; 13:33. [PMID: 24006869 PMCID: PMC3766223 DOI: 10.1186/1471-2482-13-33] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 08/30/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Bouveret's syndrome causes gastric outlet obstruction when a gallstone is impacted in the duodenum or stomach via a bilioenteric fistula. It is a rare condition that causes significant morbidity and mortality and often occurs in the elderly with significant comorbidities. Individual diagnostic and treatment strategies are required for optimal management and outcome. The purpose of this paper is to develop a surgical strategy for optimized individual treatment of Bouveret's syndrome based on the available literature and motivated by our own experience. CASE PRESENTATION Two cases of Bouveret's syndrome are presented with individual management and restrictive surgical approaches tailored to the condition of the patients and intraoperative findings. CONCLUSIONS Improved diagnostics and restrictive individual surgical approaches have shown to lower the mortality rates of Bouveret's syndrome. For optimized outcome of the individual patient: The medical and perioperative management and time of surgery are tailored to the condition of the patient. CT-scan is most often required to secure the diagnosis. The surgical approach includes enterolithotomy alone or in combination with simultaneous or subsequent cholecystectomy and fistula repair. Lower overall morbidity and mortality are in favor of restrictive surgical approaches. The surgical strategy is adapted to the intraoperative findings and to the risk for secondary complications vs. the age and comorbidities of the patient.
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Affiliation(s)
- Felix Nickel
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Matthias M Müller-Eschner
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany
| | - Jackson Chu
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Hendrik von Tengg-Kobligk
- Department of Diagnostic and Interventional Radiology, University of Heidelberg, Heidelberg, Germany
- Department of Radiology, German Cancer Research Center (dkfz), Heidelberg, Germany
- Institute of Diagnostic, Interventional and Pediatric Radiology, University Hospital Bern, Inselspital, Bern, Switzerland
| | - Beat P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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