Nguyen Bac Hoang, Le Quan Anh Tuan, Hai Pham Minh, Quang Hung Vu, Thai Truc Thanh
University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam.
Department of Hepatobiliary and Pancreatic Surgery, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam.
Int Med Case Rep J. 2020 Nov 17;13:651-656. doi: 10.2147/IMCRJ.S278058. eCollection 2020.
Duodenal obstruction due to a gallstone, also known as Bouveret's syndrome, is one type of gallstone ileus. This is a rare complication of cholelithiasis. Among gallstone ileus cases, duodenal obstruction is alsorare. Apart from rareness, diagnosis is challenging due to unspecific clinical manifestation. Treatment options have benefits and drawbacks with each as well. Therefore, setting an appropriate option in a certain patient is an important issue.
An 85-year-old woman presented clinically with a gastric outlet obstruction. Upper gastrointestinal (GI) endoscopy was attempted but endoscopic exploration was limited because of duodenum filled by fluid. Rigler's triad was detected on abdominal enhanced CT scan: duodenal obstruction, ectopic gallstone within duodenum lumen, pneumobilia. The stone was very large (9 cm long). The diagnosis was duodenal obstruction due to giant gallstone and cholecysto-duodenum fistula. The patient was treated with a radical one-stage procedure: fistulotomy for gallstone removal, cholecystectomy, side-to-side Roux-en-Y duodenojejunostomy. There were no complications related to surgery during the follow-up period.
Surgery plays an important role in management of duodenal obstruction due to a gallstone, especially a large and impacted stone. Radical one-stage surgery is one of the feasible, safe, and efficient procedures in selected patients.
胆结石导致的十二指肠梗阻，也称为布韦雷综合征，是胆石性肠梗阻的一种类型。这是胆石症的一种罕见并发症。在胆石性肠梗阻病例中，十二指肠梗阻也很罕见。除了罕见之外，由于临床表现不具特异性，诊断具有挑战性。治疗方案也各有优缺点。因此，为特定患者选择合适的治疗方案是一个重要问题。
一名85岁女性临床上表现为胃出口梗阻。尝试进行上消化道内镜检查，但由于十二指肠充满液体，内镜探查受限。腹部增强CT扫描发现里格勒三联征：十二指肠梗阻、十二指肠腔内异位胆结石、气腹。结石非常大（9厘米长）。诊断为巨大胆结石和胆囊十二指肠瘘导致的十二指肠梗阻。患者接受了一期根治性手术：切开瘘管取出结石、胆囊切除术、侧侧吻合的Roux-en-Y十二指肠空肠吻合术。随访期间无手术相关并发症。
手术在胆结石导致的十二指肠梗阻的治疗中起着重要作用，尤其是对于大的嵌顿结石。一期根治性手术是部分合适患者可行、安全且有效的手术方法之一。
