bouveretâ•Žs syndrome: definitive diagnosis with
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Lehigh Valley Health NetworkLVHN Scholarly Works
Department of Medicine
Bouveret’s Syndrome: Definitive Diagnosis withEsophagogastroduodenoscopyPatrick Hickey DOLehigh Valley Health Network, [email protected]
Matthew Sullivan DOLehigh Valley Health Network, [email protected]
Saba Ahmad MDLehigh Valley Health Network, [email protected]
James Cornell MDLehigh Valley Health Network, [email protected]
Shashin Shah MDLehigh Valley Health Network, [email protected]
See next page for additional authors
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Published In/Presented AtHickey, P., Sullivan, M., Ahmad, S., Cornell, J., Shah, S., & Shah, H. (2014, October 17). Bouveret’s Syndrome: Definitive Diagnosis withEsophagogastroduodenoscopy. Poster session presented at the American College of Gastroenterology Annual Scientific Meeting,Philadelphia, PA.
AuthorsPatrick Hickey DO, Matthew Sullivan DO, Saba Ahmad MD, James Cornell MD, Shashin Shah MD, and HiralN. Shah MD
This poster is available at LVHN Scholarly Works: http://scholarlyworks.lvhn.org/medicine/834
© 2014 Lehigh Valley Health Network
References:1 CappellM,DavisM.CharacterizationofBouveret’ssyndrome:acomprehensive
reviewof128cases.The American Journal Of Gastroenterology[serialonline].September2006;101(9):2139-2146.
2 MavroeidisV,MatthioudakisD,EconomouN,KaranikasI.Bouveretsyndrome–therarestvariantofgallstoneileus:acasereportandliteraturereview.Case Reports in Surgery [serialonline].2013;2013:839370.
Background•Definition:Bouveret’ssyndromeisararevariantofgallstoneileuscharacterizedbyupperGI
obstructionfromanimpactedgallstoneinthesettingofbilioentericfistula•�Presentation:Elderlyfemaleswithnausea,vomiting,andupperabdominalpain•Diagnosis:Usuallymadewithimagingorendoscopy - Rigler’striadofgallstoneileusconsistsofasmallbowelobstruction,pneumobilia,andanectopicradiopaquegallstone
onx-ray
•Treatment:Commonlysurgicalremoval,butendoscopicextractionandlithotripsyhavebeendescribed
•WereportararecaseofBouveret’ssyndromeanddescribeitsendoscopicdiagnosisandsurgicalmanagement
Images
Discussion•FrenchinternistLeonBouveretfirstdescribedthesyndromein1896•Bouveret’ssyndromeisararedifferentialdiagnosisforuppergastrointestinal
obstructioninelderlypatients•Surgicalawarenessandpossibleinterventioniswarrantedinsuch
complicatedcases•Inthiscasewedemonstratethevalueofendoscopytodiagnoseandguide
thetreatmentofBouveret’ssyndromewithnon-diagnosticimaging
CTscanoftheabdomenandpelvisshowingapossiblecholecystoduodenalfistulawith
pneumobilia,possiblenonopaquegallstoneinthethirdportionoftheduodenum,andupper
gastrointestinalobstruction
Case�Presentation•An80year-old-femalepresentswithintractablenauseaandvomitingoftwodaysduration
associatedwithmildrightupperquadrantpain•CTScan: - Evidenceofapossiblecholecystoduodenalfistulawithpneumobilia - Possiblenon-opaquegallstonewithinthethirdportionoftheduodenum - Uppergastrointestinalobstruction
•EGDperformedfordefinitivediagnosisandattemptedtreatment: - Twolitersofbiliousfluidandgastriccontentswereremovedfromtheesophagusandstomach - Secondportionoftheduodenumhadgranulatedulcerationandpusconsistentwithcholecystoduodenalfistula - Distalthirdportionoftheduodenumrevealedcompletelumenobstructionwithamassofblack-and-whitematerial
composedofgallstonesanddebris - Theentiremasscouldnotbemobilizeddespiteeffortswithaneedleknifetobreakthestone
•Subsequentexploratorylaparotomyallowedsurgicalremovalofa5.5x3.5x3.5cmgallstonefromduodenotomysite
•Duringthesurgicalprocedurethefistulawasleftintactbecauseitwasscarredandnotwellvisualized
•Agastrojejunaltubewasplacedfortubefeedingsandshewasquicklyadvancedtoasoliddiet•Shewasdischargedhomeinstableandimprovedconditionaweekaftersurgicalintervention,and
continuestodowellinfollow-up
Abdominalx-rayshowingpneumobiliaandgastricoutletobstruction
EGD:Secondportionoftheduodenumshowinggranulatedulcerationandpusconsistentwith
cholecystoduodenalfistula
EGD:Distalthirdportionoftheduodenumshowingcompleteluminalobstructionbya
gallstoneanddebris
UpperGIseriespriortodischargeshowingdelayedgastricemptyingbutnoevidenceofsignificant
obstruction
Lehigh Valley Health Network, Allentown, PA
Bouveret’s Syndrome: Definitive Diagnosis with EsophagogastroduodenoscopyPatrick Hickey DO, Matthew Sullivan DO, Saba Ahmad MD, James Cornell MD, Shashin Shah MD and Hiral Shah MD