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Bouveret's Syndrome Complicated by Classic Gallstone Ileus: Progression of Disease or Iatrogenic?
- Source :
- Journal of Gastrointestinal Surgery. 17:2020-2024
- Publication Year :
- 2013
- Publisher :
- Springer Science and Business Media LLC, 2013.
-
Abstract
- Bouveret's syndrome is a rare variant of gallstone ileus resulting in gastroduodenal obstruction from an impacted gallstone. We report two cases of Bouveret's syndrome that were complicated by classic (distal) gallstone ileus, which has previously been reported only twice. The first patient presented with vomiting, epigastric pain, and what was initially believed to be a duodenal diverticulum on computed tomography scan and endoscopy. He initially improved, but later developed symptoms of a small bowel obstruction. Repeat imaging revealed a classic distal gallstone ileus. The second patient presented with nausea, abdominal pain, and imaging consistent with Bouveret's syndrome. Multiple non-operative endoscopic techniques and extracorporeal shock wave lithotripsy were employed to fragment and retrieve the obstructing stone, and she subsequently developed a distal gallstone ileus from a stone fragment. Both patients were managed operatively with enterotomy and stone removal. These cases highlight a rare complication of Bouveret's syndrome, classic (distal) gallstone ileus, and juxtapose the natural history of a stone passing versus an iatrogenic etiology. We review the presentation and management of Bouveret's syndrome though no clear consensus exists as to the optimal treatment of these patients. We recommend that therapy should be decided on a case-by-case basis.
- Subjects :
- Male
medicine.medical_specialty
Abdominal pain
Vomiting
Nausea
medicine.medical_treatment
Gallstones
Enterotomy
Ileus
Gallstone ileus
medicine
Humans
Duodenal Diseases
Aged
medicine.diagnostic_test
business.industry
General surgery
Gastroenterology
Gastric outlet obstruction
Syndrome
Middle Aged
medicine.disease
Extracorporeal shock wave lithotripsy
digestive system diseases
Abdominal Pain
Endoscopy
Surgery
Bowel obstruction
Female
medicine.symptom
business
Intestinal Obstruction
Subjects
Details
- ISSN :
- 18734626 and 1091255X
- Volume :
- 17
- Database :
- OpenAIRE
- Journal :
- Journal of Gastrointestinal Surgery
- Accession number :
- edsair.doi.dedup.....397726d4b185001b94508051305255ae