Abstract
IntroductionBouveret's syndrome is a clinically distinct form of gallstone ileus caused by the formation of a fistula between the biliary tract and duodenum. This case reinforces the need for early recognition and treatment of Bouveret's syndrome, as it is associated with high morbidity and mortality rates.Case presentationAn 82-year-old Caucasian woman presented with signs and symptoms of small bowel obstruction. Her laboratory workup showed elevated alkaline phosphatase and amylase levels. Computed tomography of her abdomen revealed pneumobilia, a choledochoduodenal fistula and a gallstone obstructing her distal duodenum. The impacted gallstone could not be extracted endoscopically, so our patient underwent open enterolithotomy successfully. However, the postoperative course was complicated by myocardial infarction, respiratory failure and disseminated intravascular coagulation. She died 22 days after surgery, secondary to cardiopulmonary arrest.ConclusionThis case clearly highlights the considerable morbidity and mortality associated with Bouveret's syndrome.
Highlights
Bouveret’s syndrome is a clinically distinct form of gallstone ileus caused by the formation of a fistula between the biliary tract and duodenum
Bouveret’s syndrome is defined as a cholecystoduodenal or choledochoduodenal fistula with the passage of a gallstone into the duodenum or pylorus leading to gastric outlet obstruction [1]
There have been very few case reports about this syndrome published in the last 100 years because of its rarity
Summary
Bouveret’s syndrome is defined as a cholecystoduodenal or choledochoduodenal fistula with the passage of a gallstone into the duodenum or pylorus leading to gastric outlet obstruction [1]. A CT scan of her abdomen and pelvis with contrast (Figure 1) showed pneumobilia with a choledochoduodenal fistula (common bile duct and second part of her duodenum), significant wall thickening of the second portion of her duodenum and a large 3.6 cm gallstone obstructing her distal duodenum (Figures 2 and 3). Her stomach and proximal duodenum were dilated with decompression of the distal small and large bowel loops. Our patient died 22 days after surgery secondary to cardiopulmonary arrest
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