Department of General and HPB Surgery, Royal Blackburn Hospital, Blackburn, UK
Department of Radiology, Royal Blackburn Hospital, Blackburn, UK.
BMJ Case Rep. 2021 Feb 9;14(2):e238326. doi: 10.1136/bcr-2020-238326.
An 81-year-old woman, diabetic and hypertensive, presented with nausea and intermittent vomiting. She had dysphagia and loss of appetite for over 6 weeks and significant weight loss over 3 weeks and was admitted in general surgery unit on emergency basis. Investigations revealed dilated stomach and a stone in first part of duodenum, with probable site of obstruction at level of first part of duodenum, secondary to a cholecystoduodenal fistula. With a preoperative diagnosis of Bouveret's syndrome, she underwent laparotomy and subtotal cholecystectomy. Postoperative recovery was delayed due to gastroparesis and delayed gastric emptying which resolved with conservative management. Successful management of this case required a multidisciplinary team approach. Early diagnosis was the key to management. Mode of treatment and management of Bouveret's syndrome should be tailored to suit patient's age, comorbidities and performance status.
一位 81 岁的女性，患有糖尿病和高血压，出现恶心和间歇性呕吐。她有吞咽困难和食欲不振超过 6 周，体重在 3 周内显著减轻，并因急症被收入普通外科病房。检查发现胃扩张和十二指肠第一段结石，可能在十二指肠第一段水平有梗阻部位，继发于胆肠瘘。术前诊断为 Bouveret 综合征，她接受了剖腹手术和胆囊次全切除术。由于胃轻瘫和胃排空延迟，术后恢复延迟，经保守治疗后得到解决。成功治疗该病例需要多学科团队方法。早期诊断是治疗的关键。Bouveret 综合征的治疗方式和管理应根据患者的年龄、合并症和身体状况进行调整。
