Thant Phyu Cin, Thomas Rebecca
Lyell McEwin Hospital, South Australia, Australia.
Lyell McEwin Hospital, South Australia, Australia.
Int J Surg Case Rep. 2023 Apr;105:108029. doi: 10.1016/j.ijscr.2023.108029. Epub 2023 Mar 22.
Bouveret syndrome is a rare type of gallstone ileus causing gastric outlet obstruction with high morbidity and mortality risk, and hence important to have a high degree of clinical suspicion on presentation for prompt diagnosis and management.
We present a case of an elderly woman with abdominal pain, haematemesis, and an unremarkable radiograph whose initial emergent endoscopy showed a gastric obstruction and a duodenal diverticulum with a non-bleeding broad based duodenal ulcer. Subsequent computerised tomographic (CT) scan revealed a cholecystoduodenal fistula and gastric outlet obstruction secondary to a 5 cm stone in the duodenojejunal (DJ) flexure. A repeat endoscopy was attempted for endoscopic removal prior to proceeding to open enterolithotomy.
This case highlights the challenges in diagnosis and discusses the latest literature on multimodal management consisting of endoscopy and surgery.
The location of the obstructing stone at the duodenojejunal flexure is extremely rare and therefore will add to world literature on Bouveret syndrome.
布韦雷综合征是一种罕见的胆石性肠梗阻类型，可导致胃出口梗阻，具有较高的发病率和死亡风险，因此在出现症状时高度的临床怀疑对于及时诊断和治疗至关重要。
我们报告一例老年女性患者，有腹痛、呕血症状，X线平片未见异常，初次急诊内镜检查显示胃梗阻以及十二指肠憩室合并一个无出血的广基十二指肠溃疡。随后的计算机断层扫描（CT）显示存在胆囊十二指肠瘘以及继发于十二指肠空肠（DJ）曲部一个5厘米结石的胃出口梗阻。在进行开放性肠石切除术之前，尝试再次进行内镜检查以进行内镜下取出。
该病例突出了诊断方面的挑战，并讨论了关于由内镜检查和手术组成的多模式治疗的最新文献。
梗阻性结石位于十二指肠空肠曲部极为罕见，因此将补充关于布韦雷综合征的世界文献。
