Bouveret's syndrome and biliary ileus. An extremely rare cause of gastric obstruction

Abstract

Blackground: Bouveret’s syndrome and biliary ileus, an extremely rare cause of gastric obstruction (about 300 cases published about Bouveret’s syndrome), is due to the impaction of a duodenal calculus secondary to a cholecystoduodenal or cholecystogastric fistula. It is associated with women, with more than 70 years old and large gallstones. The surgical treatment depends of the patient, the side of the calculus and its location. Surgical treatment is enterolithotomy with or without cholecystectomy. The fistula can close spontaneously so its repair may be unnecessary. The aim is to present two cases of biliary ileus and we do a bibliographic review to know its management. Material & Methods: The first patient was an 81 years old male who consulted in the emergency room for oral intolerance and vomiting. A CT study was performed, finding a cholecystoduodenal fistula and lithiasis that causes intestinal obstruction in the duodenum (figure 1). The other patient, was an 91 years old female who consulted in the emergency room for vomiting. In CT we could see a cholecystoduodenal fistula and a lithiasis in ileon that caused intestinal obstruction. Results: First patient underwent surgery with enterolithotomy. Six days after surgery, the patient was discharged home without symptoms. In the second case, the patient needed surgery with enterolithtomy, cholecystectomy and closure of the duodenum. In Conclusion: in these patients, intestinal obstruction must be treated first with an enterolithotomy and a biliary procedure, including cholecystectomy and biliary-enteric fistula closure, in low-risk patients.