Wittenburg Henning, Mössner Joachim, Caca Karel
University of Leipzig, Department of Medicine II, Leipzig 04103, Germany.
Ann Hepatol. 2005 Apr-Jun;4(2):132-4.
We describe the case of a 73-year-old woman was admitted to our hospital because of constant abdominal pain in her right upper quadrant and postprandial bloating and fullness for several months. On abdominal x-ray the extrahepatic bile ducts were positive for gas and on ultrasound a gallstone in the duodenum was suspected whereas the gallbladder was not detectable. An upper gastrointestinal endoscopy confirmed a large gallstone that was impacted in the duodenal bulb ("Bouveret's syndrome"). The gallstone was fragmented employing mechanical lithotripsy and removed. Duodenoscopy revealed a cholecystoduodenal fistula and a second gallstone in the gallbladder. The patient underwent open cholecystectomy with closure of the cholecystoduodenal fistula and made a full recovery. We conclude that in patients with upper abdominal pain and pneumobilia on x-ray the unusual complication of cholelithiasis with an impacted gallstone in the duodenal bulb should be suspected. In those rare cases of Bouveret's syndrome endoscopic removal of the gallstone should be attempted to minimize the necessary surgical procedure whenever possible.
我们描述了一名73岁女性的病例，她因右上腹持续腹痛以及餐后腹胀和饱胀感数月而入院。腹部X线检查显示肝外胆管有气体，超声检查怀疑十二指肠有胆结石，而胆囊未被检测到。上消化道内镜检查证实十二指肠球部有一枚大的胆结石嵌顿（“布韦里综合征”）。采用机械碎石术将胆结石破碎并取出。十二指肠镜检查发现胆囊十二指肠瘘和胆囊内的另一枚胆结石。患者接受了开腹胆囊切除术并关闭了胆囊十二指肠瘘，完全康复。我们得出结论，对于有上腹部疼痛且X线显示有气腹的患者，应怀疑胆石症的罕见并发症——十二指肠球部有嵌顿胆结石。在那些罕见的布韦里综合征病例中，应尝试内镜下取出胆结石，尽可能减少必要的手术操作。
