Yang Kevin J, Chang C K
University of California, Berkeley, CA, USA.
Kaiser Permanente, Oakland, CA, USA.
Case Rep Gastrointest Med. 2020 Mar 16;2020:1837387. doi: 10.1155/2020/1837387. eCollection 2020.
Bouveret syndrome, a specific form of gallstone ileus, is the obstruction of the gastric outlet by a gallstone, which can enter the duodenum through a fistula. While the average age of individuals with Bouveret syndrome is 74 years, our patient was 42 years of age at the time of operation, significantly younger than the average patient afflicted with this condition. In the treatment of our patient's condition, the operation conducted entailed a partial duodenectomy, gastrojejunostomy, cholecystectomy, common bile duct exploration, extraction of bile duct stones, and insertion of a t-tube in the bile duct. The patient was found to be in healthy condition upon check-up six months after the operation. The outcome of our case suggests that younger Bouveret patients can safely undergo multiple surgical procedures in the treatment of Bouveret syndrome. Our case also suggests that a cholecystectomy and the removal of the obstructing gallstone can both be carried out within one operation, although coupling these two procedures in one operation might be riskier for patients within the normal age range of Bouveret syndrome. We also suggest that fistula repair be carried out for younger Bouveret patients in particular and that the patient be subjected to a CT scan in the diagnosis of Bouveret syndrome when this condition is suspected.
布韦雷综合征是胆石性肠梗阻的一种特殊形式，是指胆结石阻塞胃出口，胆结石可通过瘘管进入十二指肠。布韦雷综合征患者的平均年龄为74岁，而我们的患者在手术时年仅42岁，明显低于患此病的平均患者年龄。在治疗我们这位患者的病情时，所进行的手术包括部分十二指肠切除术、胃空肠吻合术、胆囊切除术、胆总管探查、取出胆管结石以及在胆管中插入T形管。术后六个月检查时发现患者身体状况良好。我们这个病例的结果表明，较年轻的布韦雷综合征患者在治疗该综合征时可以安全地接受多种外科手术。我们的病例还表明，胆囊切除术和取出阻塞性胆结石这两个手术可以在一次手术中同时进行，尽管对于处于布韦雷综合征正常年龄范围内的患者而言，在一次手术中合并这两个手术可能风险更大。我们还建议，尤其对于较年轻的布韦雷综合征患者应进行瘘管修复，并且在怀疑患有布韦雷综合征时，应对患者进行CT扫描以进行诊断。
