Endoscopic treatment of Bouveret syndrome

Czech version

Authors: N. Ghaleb; P. Fojtík
Authors‘ workplace: Centrum péče o zažívací trakt, Vítkovická nemocnice, a. s., Ostrava
Published in: Gastroent Hepatol 2018; 72(1): 73-76
Category: Digestive Endoscopy: Case Report
doi: https://doi.org/10.14735/amgh201873

Overview

Bouveret syndrome is a rare complication of cholecystolithiasis in which a gallstone travels into the duodenum via a cholecystogastric or cholecystoduodenal fistula, leading to decreased digestive propulsion and symptoms of gastric outlet obstruction. In this case report, we describe successful endoscopic treatment of Bouveret syndrome in an elderly male patient without serious ailments. The personal history of the patient revealed he had experienced one attack of biliary colic, without any mention of dyspeptic symptoms. The patient began to suffer from recurrent vomiting after a dietary mistake following his admittance to a long-term geriatric ward in order to treat his repetitive attacks of gout. After surgical examination, the patient underwent a series of imaging analyses. An abdominal X-ray did not show any sign of ileus and an abdominal ultrasound scan did not visualise the gallbladder; however, gastric distension was detected. Therefore, we performed an endoscopy to examine the stomach. A large impacted gallstone was found in the region of the duodenal bulb. It was not possible to extract the entire gallstone via the oesophagus because part of it was stenotic; therefore, mechanical lithotripsy was performed. The crushed gallstone were left in the gastrointestinal tract. A follow-up ultrasound scan visualised the gallbladder filled with stones; however, surgery was not performed. Bouveret syndrome is more frequent in elderly patients with multiple diseases and is therefore associated with a high mortality rate. Attempts should be made to retrieve gallstones via endoscopy, even though the success rate is variable. Surgical procedures, such as enterotomy, duodenotomy and gastrotomy, should only be performed after endoscopic retrieval has failed.

Key words:
Bouveret syndrome – gastric outlet obstruction – gallstone ileus – gastroscopy – lithotripsy

Submitted:
24. 5. 2017

Accepted:
26. 9. 2017

The authors declare they have no potential conflicts of interest concerning drugs,products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Sources

1. Lowe AS, Stephenson S, Kay CL et al. Duodenal obstruction by gallstone (Bouveret‘s syndrome): a review of the literature. Endoscopy 2005; 37 (1): 82–87.

2. Bouveret L. Stenose du pylore adherent a la vesicule. Rev Med (Paris) 1896; 16: 1–16.

3. Cappell MS, Davis M. Characterization of Bouveret‘s syndrome: a comprehensive review of 128 cases. Am J Gastroenterol 2006; 101 (9): 2139–2146.

4. Ehrman J, Hůlek P. Hepatologie 2010. 1. vyd. Praha: Grada 2014: 521–524.

5. Langhorst J, Schumacher B, Deselaers T et al. Successful endoscopic therapy of a gastric outlet obstruction due to a gallstone with intracorporeal laser lithotripsy: a case of Bouveret‘s syndrome. Gastrointest Endosc 2000; 51 (2): 209–213.

6. Friedland JA, Hruza DS, Fisher AJ. CT, MR cholangiopancreatography, and endoscopy findings in Bouveret‘s syndrome. AJR Am J Roentgenol 2003; 180 (4): 1033–1035.

7. Frattaroli FM, Reggio D, Guadalaxara A et al. Bouveret‘s syndrome: case report and review of the literature. Hepatogastroenterology 1997; 44 (16): 1019–1022.

8. Kajzrlíková I. Bouveretův syndrom přecházející v plně vyjádřený biliární ileus. [online]. Dostupné z: www.kolonoskopie.cz/pripad-mesice/2010/duben-1/bouveretuv-syndrom-prechazejici-v-plne-vyjadreny-biliarni-ileus.aspx.

9. Šimůnek R, Bohatá S, Kala Z. Bouveretův syndrom – raritní případ vysokého ileu. Rozhl Chir 2009, 88 (3): 119–122.

10. Grove O. Acute pyloric obstruction by gallstone: report of a case diagnosed by gastroscopy. Gastrointest Endosc 1976; 22 (4): 212–213.

11. Tüney D, Çimşit C. Bouveret‘s syndrome: CT findings. Eur Radiol 2000; 10 (11): 1711–1712.

12. Trubek S, Bhama JK, Lamki N. Radiological findings in Bouveret‘s syndrome. Emergency Radiology 2001; 8 (6): 335–337.

13. Holl J, Sackmann M, Hoffmann R et al. Shock-wave therapy of gastric outlet syndrome caused by a gallstone. Gastroenterology 1989; 97 (2): 472–474.

14. Rodríguez-Sanjuán JC, Casado F, Fernández MJ et al. Cholecystectomy and fistula closure versus enterolithotomy alone in gallstone ileus. Br J Surg 1997; 84 (5): 634–637.

15. Bhama JK, Ogren JW, Lee T et al. Bouveret‘s syndrome. Surgery 2002; 132 (1): 104–105.

16. Reisner RM, Cohen JR. Gallstone ileus: a review of 1001 reported cases. Am Surg 1994; 60 (6): 441–446.

17. Zuegel N, Hehl A, Lindemann F et al. Advantages of one-stage repair in case of gallstone ileus. Hepatogastroenterology 1997; 44 (13): 59–62.

18. Sica GS, Sileri P, Gaspari AL. Laparoscopic treatment of Bouveret‘s syndrome presenting as acute pancreatitis. JSLS 2005; 9 (4): 472–475.

19. Misra MC, Grewal H, Kapur BM. Spontaneous choledochoduodenal fistula complicating peptic ulcer disease – a case report. Jpn J Surg 1989; 19 (3): 367–369.

20. Iso Y, Yoh R, Okita R et al. Choledochoduodenal fistula: a rare complication of a penetrated duodenal ulcer. Hepatogastroenterology 1996; 43 (9): 489–491.

21. Marshall SF, Polk RC. Spontaneus internal biliary fistulas. Surg Clin North Am 1958; 38 (3): 679–691.

22. Shah P, Ramakantan R. Choledochoduodenal fistula complicating duodenal ulcer disease (a report of 3 cases). J Postgrad Med 1990; 36 (3): 167–168.

23. Sarr MG, Shepard AJ, Zuidema GD. Choledochoduodenal fistula: an unusual complication of duodenal ulcer disease. Am J Surg 1981; 141 (6): 736–740.

24. Mavroeidis VK, Matthioudakis DI, Economou NK et al. Bouveret syndrome – the rarest variant of gallstone ileus: a case report and literature review. Case Rep Surg 2013; 2013: 839370. doi: 10.1155/2013/839370.

25. Patel A, Agarwal S. The yellow brick road of Bouveret syndrome. Clin Gastroenterol Hepatol 2014; 12 (8): A24. doi: 10.1016/j.cgh.2014.03.028.