Qasaimeh Ghazi Raji, Bakkar Sohail, Jadallah Khaled
1 Department of General Surgery, King Abdullah University Hospital (KAUH), Jordan University of Science and Technology (JUST), Irbid, Jordan.
Int Surg. 2014 Nov-Dec;99(6):819-23. doi: 10.9738/INTSURG-D-14-00087.1.
Bouveret's syndrome is a rare cause of gastric outlet obstruction. Its diagnosis is often delayed or overlooked. It is characterized by the passage of a large gall bladder stone through a bilio-duodenal fistula, which becomes lodged in the duodenum causing duodenal obstruction. We report the case of a 70-year-old male with a history suggestive of gall bladder disease over a 1-year period. The diagnosis was confirmed by ultrasound, which showed a single large gall bladder stone and the patient was planned for elective laparoscopic cholecystectomy. One week prior to the elective surgery he presented with upper gastrointestinal bleeding for which he was admitted, diagnosed by a gastroenterologist as bleeding duodenal ulcer and treated by local epinephrine injection and blood transfusion. One week later he presented with a picture of acute gastric outlet obstruction, which proved by endoscopy to be due to a large stone impacted in the duodenum. Endoscopic management failed and the stone was managed by open surgery. The patient made a good postoperative recovery and for the last year he has remained free of symptoms.
布韦雷氏综合征是胃出口梗阻的罕见病因。其诊断常常延迟或被忽视。它的特征是一颗大的胆囊结石通过胆十二指肠瘘排出，结石嵌顿于十二指肠导致十二指肠梗阻。我们报告一例70岁男性病例，其在1年期间有提示胆囊疾病的病史。超声检查确诊，显示有一颗单一的大胆囊结石，该患者计划接受择期腹腔镜胆囊切除术。在择期手术前一周，他出现上消化道出血而入院，胃肠病学家诊断为十二指肠溃疡出血，并通过局部注射肾上腺素和输血进行治疗。一周后，他出现急性胃出口梗阻的症状，经内镜检查证实是由于一颗大结石嵌顿于十二指肠所致。内镜治疗失败，结石通过开放手术取出。患者术后恢复良好，在过去一年中一直无症状。
