Kulkarni Dattaprasanna R, Goradia Pooja P, Kulkarni Neha D, Garge Shrikant
Gastrointestinal Surgery, Lilavati Hospital & Research Center, Mumbai, IND.
Gastrointestinal Surgery, Liver & Pancreas Clinic, Mumbai, IND.
Cureus. 2023 Apr 26;15(4):e38152. doi: 10.7759/cureus.38152. eCollection 2023 Apr.
Multiple cholecystoenteric fistulae, Bouveret syndrome (a form of gallstone ileus), and acute pancreatitis occurring together is very rare. Diagnosis is seldom clinical and is mostly based on computerised tomography (CT) or magnetic resonance imaging (MRI). Endoscopy and minimally invasive surgery have revolutionised the treatment of Bouveret syndrome and cholecystoenteric fistula, respectively, over the last two decades. Laparoscopic repair of cholecystoenteric fistula followed by cholecystectomy is successful on a consistent basis with skilled laparoscopic suturing and advanced laparoscopy. In patients with Bouveret syndrome, when the stone is <4cm and is in the proximal duodenum, it is usually amenable for endoscopic extraction with snares, nets, forceps and lithotripsy. When endoscopy is unavailable or fails, laparoscopic surgery is suitable for these patients. However, stones >4 cm, located in the distal duodenum, multiple fistulae, and associated acute pancreatitis may necessitate open surgery. We present here a case of a 65-year-old Indian female with multiple cholecystoenteric fistulae and Bouveret syndrome with acute pancreatitis with a 6.5 cm gallstone diagnosed on CT scan and MRI and treated successfully by open surgery. We also review the current literature on the management of this complex problem.
胆囊肠瘘、布韦雷综合征（一种胆石性肠梗阻）和急性胰腺炎同时发生的情况非常罕见。诊断很少基于临床症状，大多依靠计算机断层扫描（CT）或磁共振成像（MRI）。在过去二十年中，内镜检查和微创手术分别彻底改变了布韦雷综合征和胆囊肠瘘的治疗方式。通过熟练的腹腔镜缝合技术和先进的腹腔镜设备，腹腔镜修复胆囊肠瘘后行胆囊切除术一直都很成功。对于布韦雷综合征患者，当结石直径小于4cm且位于十二指肠近端时，通常可通过圈套器、网篮、钳子和碎石术进行内镜取石。当无法进行内镜检查或内镜检查失败时，腹腔镜手术适用于这些患者。然而，结石直径大于4cm、位于十二指肠远端、存在多个瘘管以及伴有急性胰腺炎时，可能需要进行开放手术。我们在此报告一例65岁的印度女性患者，她患有多个胆囊肠瘘、布韦雷综合征并伴有急性胰腺炎，CT扫描和MRI检查发现一枚6.5cm的胆结石，最终通过开放手术成功治疗。我们还回顾了有关这一复杂问题治疗的当前文献。
