Bouveret Syndrome Resolved by a Two-Staged Endoscopic and Surgical Approach

Caltenco-Solís Rb,Echeverry-Fernandez Ca,Torrejon-Hernandez Ca,Hidalgo-Delgado Jn,Magana-Salcedo Jr,Gamboa-Ramirez F,Radilla-Flores Mdc,Bizueto-Rosas H,Perez-González Ha

doi:10.16966/2470-0991.222

Abstract

Bouveret Syndrome Resolved by a Two-Staged Endoscopic and Surgical Approach

Highlights

Among the rare complications of cholecystitis is gallstone ileus and the least common is Bouveret syndrome, more frequent in older women
The diagnosis of Bouveret syndrome requires a high index of suspicion in those patients with a history of cholelithiasis and symptoms of intestinal occlusion
It is known as biliary ileum when the stone is generally embedded in a loop of the small intestine; a rare complication of cholelithiasis; uncommon cause of intestinal occlusion or acute abdomen (0.5-4%), secondary to the mechanical and obstructive effect of the stone in the intestinal lumen; the calculations can be multiple

Summary

Discussion

There are no specific data on laboratory tests for Bouveret syndrome; there may be leukocytosis, elevated liver enzymes, or electrolyte changes [12]. We must bear in mind that the clinical data is nonspecific and that the initial diagnostic approach will be different in most cases; in patients with intestinal occlusion symptoms, abdominal radiographs can be requested in two projections, diagnosing only 21% of cases. When this condition presents data of pain in the right upper quadrant or epigastrium, acute cholecystitis can be suspected, so the requested study would be an abdominal ultrasound that can detect structural changes in the gallbladder, pneumobilia, or a stone in the duodenum [2,3]. Despite our patient referring to evacuate one stone, there are reports on multiple stones and the fact that she required a second admission due to GI bleeding forced us to offer a definite approach by open surgery

Conclusion

Introduction

Findings