Louis Mena, Ayinde Bolaji, Grabill Nathaniel, Gibson Brian
Northeast Georgia Health System, Graduate Medical Education Department, 743 Spring Street NE Gainesville, GA 30501.
Northeast Georgia Medical Center, Graduate Medical Education Department, 743 Spring Street NE Gainesville, GA 30501.
Radiol Case Rep. 2025 Mar 8;20(5):2422-2427. doi: 10.1016/j.radcr.2025.02.039. eCollection 2025 May.
Bouveret syndrome, a rare form of gastric outlet obstruction, occurs when a large gallstone migrates through a cholecystoenteric fistula into the duodenum, causing obstruction. We report a 31-year-old female who initially presented with nausea, vomiting, and abdominal pain. Imaging identified a large, calcified gallstone, a hepatic abscess, and acute cholecystitis. Initial treatment involved drainage of the hepatic abscess and antibiotics, with plans for elective cholecystectomy. Three years later, she returned with recurrent symptoms, including early satiety, significant weight loss, and gastric outlet obstruction. Endoscopy confirmed duodenal obstruction, and further imaging revealed a cholecystoduodenal fistula. She underwent an open cholecystectomy with fistula excision, duodenal repair, and nasojejunal feeding tube placement. Her postoperative recovery was smooth, with a gradual return to enteral nutrition. This report presents essential diagnostic and treatment approaches for Bouveret syndrome, including the roles of imaging, endoscopy, and surgery in managing complex cases. Early recognition and a coordinated, individualized treatment plan are crucial to optimizing outcomes in this rare condition.
布韦雷综合征是胃出口梗阻的一种罕见形式，当一颗大的胆结石通过胆囊肠瘘迁移至十二指肠并造成梗阻时就会发生。我们报告了一名31岁女性，她最初表现为恶心、呕吐和腹痛。影像学检查发现一颗大的钙化胆结石、一个肝脓肿和急性胆囊炎。初始治疗包括肝脓肿引流和使用抗生素，并计划择期行胆囊切除术。三年后，她因复发症状再次就诊，包括早饱、体重显著减轻和胃出口梗阻。内镜检查证实十二指肠梗阻，进一步影像学检查发现胆囊十二指肠瘘。她接受了开腹胆囊切除术，包括瘘管切除、十二指肠修复和鼻空肠营养管置入。她术后恢复顺利，逐渐恢复肠内营养。本报告介绍了布韦雷综合征的重要诊断和治疗方法，包括影像学、内镜检查和手术在处理复杂病例中的作用。早期识别以及协调、个体化的治疗方案对于优化这种罕见疾病的治疗效果至关重要。
