Jafferbhoy Sadaf, Rustum Quatullah, Shiwani Mohammed
Department of General Surgery, Barnsley District Hospital NHS Foundation Trust, Barnsley, UK.
BMJ Case Rep. 2011 Apr 1;2011:bcr0220113891. doi: 10.1136/bcr.02.2011.3891.
Bouveret's syndrome is a rare cause of intestinal obstruction caused by gallstones and is usually seen in older patients with poor medical status. The surgical treatment for these patients is controversial. The authors present a case of a 73-year-old woman who presented with coffee ground vomiting. An upper gastrointestinal endoscopy showed a big gallstone obstructing the duodenal bulb and a CT scan showed a cholecystoduodenal fistula. The stone could not be removed or crushed endoscopically and a laparotomy was undertaken to relieve the obstruction. The stone was removed by gastrotomy and a delayed cholecystectomy was not offered due to her co-morbid conditions. She presented 18 months later with pancreatitis and has now been offered an elective cholecystectomy.
布韦雷氏综合征是由胆结石引起的一种罕见的肠梗阻病因，多见于身体状况较差的老年患者。对这些患者的手术治疗存在争议。作者报告了一例73岁女性患者，该患者出现咖啡渣样呕吐。上消化道内镜检查显示一枚大的胆结石阻塞十二指肠球部，CT扫描显示胆囊十二指肠瘘。结石无法通过内镜取出或粉碎，遂进行剖腹手术以解除梗阻。通过胃切开术取出结石，由于其合并症未进行延期胆囊切除术。18个月后她因胰腺炎就诊，目前已接受择期胆囊切除术。
