Abstract
Bouveret's Syndrome is obstruction of the duodenum secondary to an impacted gallstone, usually without the presence of pneumobilia. With the steadily increasing life expectancy, greater numbers of these cases are being seen. Gallstones enter the gastrointestinal tract following fistula formation between the gallbladder and an adjacent hollow viscus and may cause obstruction at any point along the intestinal tract. Duodenal obstruction is the least common and represents only a very small percentage of cases. The presenting signs of nausea vomiting, abdominal cramping, and the absence of abdominal distension should alert the clinician to pathology in the proximal small bowel. The purpose of this report is to heighten the awareness of the primary care physicians, emergency room doctors, and surgeons to this diagnosis in elderly patients so that it can be included in the differential with the usual causes of gastric outlet obstruction--including ulcer disease; neoplasm; gastric volvulus; and other enteroliths, such as bezoars. Early diagnosis is critical, as these cases require urgent surgical intervention. Early resuscitation, diagnosis, and treatment are essential for a successful outcome.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Balthazar E. J., Schechter L. S. Air in gallbladder: a frequent finding in gallstone ileus. AJR Am J Roentgenol. 1978 Aug;131(2):219–222. doi: 10.2214/ajr.131.2.219. [DOI] [PubMed] [Google Scholar]
- Clavien P. A., Richon J., Burgan S., Rohner A. Gallstone ileus. Br J Surg. 1990 Jul;77(7):737–742. doi: 10.1002/bjs.1800770707. [DOI] [PubMed] [Google Scholar]
- Deitz D. M., Standage B. A., Pinson C. W., McConnell D. B., Krippaehne W. W. Improving the outcome in gallstone ileus. Am J Surg. 1986 May;151(5):572–576. doi: 10.1016/0002-9610(86)90550-7. [DOI] [PubMed] [Google Scholar]
- Lobo D. N., Jobling J. C., Balfour T. W. Gallstone ileus: diagnostic pitfalls and therapeutic successes. J Clin Gastroenterol. 2000 Jan;30(1):72–76. doi: 10.1097/00004836-200001000-00014. [DOI] [PubMed] [Google Scholar]
- Pangan J. C., Estrada R., Rosales R. Cholecystoduodenocolic fistula with recurrent gallstone ileus. Arch Surg. 1984 Oct;119(10):1201–1203. doi: 10.1001/archsurg.1984.01390220075017. [DOI] [PubMed] [Google Scholar]
- RAIFORD T. S. Intestinal obstruction caused by gallstones. Am J Surg. 1962 Sep;104:383–394. doi: 10.1016/0002-9610(62)90367-7. [DOI] [PubMed] [Google Scholar]
- Reisner R. M., Cohen J. R. Gallstone ileus: a review of 1001 reported cases. Am Surg. 1994 Jun;60(6):441–446. [PubMed] [Google Scholar]