High gallstone ileus (bouveret’s syndrome) – a case report
Abstract
Background: Mechanical ileus caused by gallstones (Bouveret syndrome) is late complication of cholelithiasis. Chronical irritation and recurrent conservativelly treated episodes of acute cholecystitis lead to weakening of gallblader wall and formation of internal biliar fistula (predominantly into duodenum). Gallstones migration through the fistula can cause intestinal obstruction, which requires surgical treatment.
Patients and methods: A case of a 78-years old female patient with high ileus is presented. Preoperative examinations (endoscopy, gastroduodenography, abdominal ultrasound, CT scan and histology) suggested duodenal obstruction due to translocated and impacted gallstone – Bouveret syndrome. Intraoperativelly this diagnosis was confirmed, gallstone removed and cholecystectomy and the cholecystoduodenal fistula repair was made.
Conclusions: The Bouveret syndrome is a rare cause of mechanical ileus. It is presented in aged patients as late complication of gallstones and demands operative treatment. Desobstruction is mandatory, according to patient’s general condition cholecystectomy and fistula repair are strongly recomended.
Downloads
References
Sabiston DC. Textbook of surgery. 15th edition. Philadelphia: W. Saunders Company; 1997.
Petersdorf RG, Adams RD, Braunwald E, Isselbacher KJ, Martin JB, et al. Harrisons Principles of internal medicine 2. 11th edition. Auckland Bogota: McGraw-Hill Book Company 1987.
Košorok P. Bouveret’s syndrome (Gallstone ileus). A Minefild B J C P 1996; 50(1): 59–60.
Košorok P. Bouveretov sindrom-visoki biliarni ileus. Med Razgl 1996; 35: 421–8.
Reisner RM, Cohen JR. Gallstone ileus: a review of 1001 reported cases. Am Surg 1994; 60: 441–6.
Štulhofer M. Kirurgija probavnog sustava. Samobor, Zagreb: Poduzeće za graf. Djelat; 1992: 430–4.
Deitz DM, Standage BA, Pinson CW, McConnell DB, Krippaehne WW. Improving the outcome in gallstone ileus. Am J Surg 1986; 151: 572–6.
Brennan GB, Rosenberg RD, Arora S. Bouveret syndrome. Radiographics 2004; 24: 1171–5.
Sanchez-Sanchez MR. Bouveret syndrome. A case report. Rev Clin Esp 2003; 203: 399–400.
Hurliman R, Enzler M, Binswanger RO, Meyenberger C. Bouveret syndrome – a rare gallstone complication. Z Gastroenterol 1995; 33 : 445–8.
Sonak R, Tusek D, Rusche HH. Bouveret syndrome – a rare form of pyloric obstruct. Zentralbl Chir 1995; 120 : 75–8.
Akcakaya A, Sahin M, Coskun A, Demiray S. Comparison of mechanical bowel obstruction cases of intraabdominal tumor and non-tumoral origin. World J Surg 2006; 12: 231–6.
Ihedioha U, Alani A, Modak P, Chong P. Hernias are the most common cause of strangulation in patients presenting with small bowel obstruction. Hernia 2006; 19: 122–5.
Lock G. Acute mesenteric ischaemia-frequently overlooked an often fatal. Med Klin 2002; 15: 402–9.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.
