School of Medicine, University of Washington, Seattlle, Washington, USA.
Surgery, Kalispell Regional Healthcare, Kalispell, Montana, USA.
BMJ Case Rep. 2021 Feb 1;14(2):e238126. doi: 10.1136/bcr-2020-238126.
A 57-year-old woman presented with a 5-day history of worsening right upper quadrant pain, bilious emesis and approximately 20 pounds of weight loss. The patient was afebrile, without jaundice and had mild tenderness in her right upper quadrant. She noted an incidental finding of asymptomatic cholelithiasis on imaging 4 years earlier. An abdominal radiograph revealed pneumobilia and a large ectopic calculus. An abdominal CT scan confirmed pneumobilia, a large concretion completely obstructing the third portion of the duodenum and a soft tissue communication between the gallbladder and proximal duodenum. She was brought to the operating room for definitive treatment and had the obstructing gallstone removed via a transverse duodenotomy. Bouveret syndrome is a rare cause of small bowel obstruction that requires a high index of suspicion for diagnosis. It should be considered in older patients with clinical evidence of gastric or duodenal obstruction, particularly with a history of cholelithiasis.
一位 57 岁女性因右上腹疼痛加剧、胆汁性呕吐和大约 20 磅体重减轻就诊，病史 5 天。患者无发热，无黄疸，右上腹有轻度压痛。她在 4 年前的影像学检查中偶然发现无症状性胆石症。腹部 X 线片显示气胆征和大的异位结石。腹部 CT 扫描证实了气胆征、完全阻塞十二指肠第三段的大结石和胆囊与近端十二指肠之间的软组织相通。她被送往手术室进行明确治疗，并通过横十二指肠切开术切除了阻塞的胆结石。Bouveret 综合征是一种罕见的小肠梗阻原因，需要高度怀疑诊断。对于有胃或十二指肠梗阻临床证据的老年患者，尤其是有胆石症病史的患者，应考虑该病。
