Sousa Mariana, Santos Madalena, Abrantes João Francisco, Peixoto Lígia
Internal Medicine, Unidade Local de Saúde Santa Maria - Hospital de Santa Maria, Lisbon, PRT.
Cureus. 2025 Jan 18;17(1):e77617. doi: 10.7759/cureus.77617. eCollection 2025 Jan.
Bouveret's syndrome, a rare and severe complication of gallstone disease, is characterized by gastric outlet obstruction resulting from the passage of a gallstone through a bilioenteric fistula, typically a cholecystoduodenal fistula. We present the case of a 68-year-old female patient with bilateral low back pain, nausea, vomiting, and constipation. Imaging revealed jejunal obstruction due to gallstone migration through a cholecystoduodenal fistula. Initial management involved nasogastric decompression and fluid resuscitation, followed by enterolithotomy. Diagnosis of Bouveret's syndrome is challenging due to nonspecific symptoms. Imaging, particularly computed tomography (CT), is essential for identifying Rigler's triad: pneumobilia, bowel obstruction, and ectopic gallstone. Early intervention is essential to avoid complications. This case highlights the complexity of diagnosing and managing Bouveret's syndrome. A high degree of clinical suspicion is essential for accurate diagnosis and timely treatment, ensuring the optimal management of Bouveret's syndrome.
布韦雷综合征是胆石症一种罕见且严重的并发症,其特征是胆结石通过胆肠瘘(通常是胆囊十二指肠瘘)导致胃出口梗阻。我们报告一例68岁女性患者,有双侧腰痛、恶心、呕吐和便秘症状。影像学检查显示胆结石通过胆囊十二指肠瘘迁移导致空肠梗阻。初始治疗包括鼻胃管减压和液体复苏,随后进行肠石切除术。由于症状不具特异性,布韦雷综合征的诊断具有挑战性。影像学检查,尤其是计算机断层扫描(CT),对于识别里格勒三联征(气腹、肠梗阻和异位胆结石)至关重要。早期干预对于避免并发症至关重要。该病例突出了布韦雷综合征诊断和管理的复杂性。高度的临床怀疑对于准确诊断和及时治疗至关重要,以确保对布韦雷综合征的最佳管理。