Varre Jaya Sai, Wu Jin Ling, Hopmann Peter, Ruiz Oscar, Reddy Raghuram
Department of General Surgery, OhioHealth Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, USA.
Ohio Gastroenterology Group, Inc., OhioHealth Riverside Methodist Hospital, 3400 Olentangy River Road, Columbus, OH 43202, USA.
J Surg Case Rep. 2021 Oct 26;2021(10):rjab464. doi: 10.1093/jscr/rjab464. eCollection 2021 Oct.
Bouveret's syndrome is a rare complication that occurs most commonly in elderly patients with multiple comorbidities. It is secondary to an impacted gallstone causing gastric outlet obstruction from a cholecystoduodenal fistula, and there is no defined standardized management in current literature. A 92-year-old woman presents to our tertiary community hospital with abdominal discomfort concerning for bowel obstruction. Computed tomography revealed pneumobilia with a cholecystoduodenal fistula and a large gallstone in the proximal duodenum causing gastric outlet obstruction. The impacted gallstone failed endoscopic extraction with electrohydraulic lithotripsy, and patient subsequently developed distal gallstone ileus requiring exploratory laparotomy and enterolithotomy. This case report examines the need for early coordinated endoscopic and surgical management of a patient with Bouveret's syndrome complicated by gallstone ileus as it is associated with high morbidity and mortality rates.
布韦雷氏综合征是一种罕见的并发症，最常发生于患有多种合并症的老年患者。它继发于嵌顿性胆结石，由胆囊十二指肠瘘导致胃出口梗阻，目前文献中尚无明确的标准化治疗方法。一名92岁女性因肠梗阻相关的腹部不适就诊于我们的三级社区医院。计算机断层扫描显示有气腹，存在胆囊十二指肠瘘，十二指肠近端有一枚大的胆结石导致胃出口梗阻。嵌顿性胆结石经内镜电液压碎石术未能取出，患者随后出现远端胆石性肠梗阻，需要进行剖腹探查和肠石切除术。本病例报告探讨了对布韦雷氏综合征合并胆石性肠梗阻患者进行早期内镜与手术协同治疗的必要性，因为该病与高发病率和死亡率相关。
