Amri Fakhrddine, Belkhayat Chifaa, Chahi Kaoutar, Aggari Hanane El, Zazour Abdelkrim, Koulali Hajar, Mqaddem Ouiam El, Skiker Imane, Kharrasse Ghizlane, Ismaili Zahi
Department of Hepato-Gastroenterology, Mohammed VI University Hospital, Oujda, Morocco.
Digestive Diseases Research Laboratory (DSRL), Faculty of Medicine and Pharmacy, Mohammed First University, Oujda, Morocco.
Radiol Case Rep. 2023 Oct 17;18(12):4549-4552. doi: 10.1016/j.radcr.2023.09.052. eCollection 2023 Dec.
Bouveret's syndrome is an uncommon cause of gastrointestinal obstruction. It's a result of the passage of a gallstone through a fistula connecting the gallbladder with the duodenum or stomach. The diagnosis is challenging due to its atypical clinical manifestations. There have been a few reported cases of Bouveret syndrome presenting with gastrointestinal bleeding. Treatment options include both endoscopic and surgical approaches. We present the case of a 92-year-old woman admitted to the emergency department for upper gastrointestinal bleeding. Gastroscopy revealed gastric stasis upstream of a calculus inducing an obstruction of the bulb. The computed tomography (CT) scan showed a cholecystoduodenal fistula with a calculus lodged in the bulb. The patient underwent a gastrostomy with extraction of the calculus. Postoperative course was uneventful and the patient was discharged home. In the majority of cases, Bouveret's syndrome is revealed by an upper gastrointestinal obstruction, but other signs, such as gastrointestinal bleeding, can be seen. The diagnosis is confirmed by an imaging method that highlights Rigler's triad. The management can be either endoscopic or surgical depending on the patient's general condition. The diagnosis is often difficult due to the lack of specificity in the symptoms. Presently, there exists no consensus concerning the appropriate approach for its management.
布韦雷氏综合征是胃肠道梗阻的一种罕见病因。它是胆结石通过连接胆囊与十二指肠或胃的瘘管所致。由于其非典型临床表现，诊断具有挑战性。已有少数布韦雷氏综合征病例表现为胃肠道出血的报道。治疗选择包括内镜和手术方法。我们报告一例92岁女性因上消化道出血入住急诊科的病例。胃镜检查显示结石上游胃潴留，导致球部梗阻。计算机断层扫描（CT）显示胆囊十二指肠瘘，结石嵌顿在球部。患者接受了胃造瘘术并取出结石。术后过程顺利，患者出院回家。在大多数情况下，布韦雷氏综合征以上消化道梗阻为首发表现，但也可见其他症状，如胃肠道出血。通过突出显示里格勒三联征的成像方法确诊。根据患者的一般状况，治疗可采用内镜或手术方式。由于症状缺乏特异性，诊断往往困难。目前，对于其合适的治疗方法尚无共识。
