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      About Digestion: 3.2 Impact Factor I 6.4 CiteScore I 0.914 Scimago Journal & Country Rank (SJR)

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      Mirizzi-Induced Bouveret's Syndrome: Revelations of Timely Surgical Intervention

      case-report

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          Abstract

          Bouveret's syndrome is an unusual clinical presentation of gastric-outlet obstruction and is the most infrequent variant of gallstone ileus with just over 300 cases in the literature. A 73-year-old female presented with innocuous constitutional symptoms and was found to have Mirizzi type Vb, a cholecystoduodenal fistula with obstruction. Esophago-gastroduodenoscopy-attempted dislodgement was unsuccessful. A gastric-jejunal bypass was the only option due to friability of the tissue. On post-op day 5, the patient developed acute abdominal pain and was found to have gallstone ileus. This case emphasizes the importance of early surgical intervention in cases of acute on chronic cholecystitis.

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          Gallstone ileus: a review of 1001 reported cases.

          M Reisner, David J. Cohen (1994)
          Although rare in the general population, gallstone ileus accounts for 25 per cent of nonstrangulated small bowel obstructions in those over the age of 65. While mortality has declined over the years, it remains high at 15-18 per cent. This is largely due to the patient population, with comorbid medical conditions contributing to mortality. The proper extent of surgery continues to be actively debated. Proponents of minimal surgery feel that relief of the obstruction is all that is required. Others argue that the gallbladder and biliary-enteric fistula must be removed to prevent future recurrence (a one-stage procedure). The one-stage procedure carries an associated mortality of 16.9 per cent, compared to 11.7 per cent for simple enterolithotomy. Morbidity after enterolithotomy is low. The recurrence rate of gallstone ileus was less than 5 per cent, and only 10 per cent of patients required reoperation for continued symptoms related to the biliary tract. Simple enterolithotomy is both safe and effective in dealing with a patient with gallstone ileus.
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            Gallstone ileus, clinical presentation, diagnostic and treatment approach.

            Mauricio Figueroa-Sanchez, María Marín-Contreras, Carlos Nuño-Guzmán … (2016)
            Gallstone ileus is a mechanical intestinal obstruction due to gallstone impaction within the gastrointestinal tract. Less than 1% of cases of intestinal obstruction are derived from this etiology. The symptoms and signs of gallstone ileus are mostly nonspecific. This entity has been observed with a higher frequency among the elderly, the majority of which have concomitant medical illness. Cardiovascular, pulmonary, and metabolic diseases should be considered as they may affect the prognosis. Surgical relief of gastrointestinal obstruction remains the mainstay of operative treatment. The current surgical procedures are: (1) simple enterolithotomy; (2) enterolithotomy, cholecystectomy and fistula closure (one-stage procedure); and (3) enterolithotomy with cholecystectomy performed later (two-stage procedure). Bowel resection is necessary in certain cases after enterolithotomy is performed. Large prospective laparoscopic and endoscopic trials are expected.
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              Characterization of Bouveret's syndrome: a comprehensive review of 128 cases.

              Michael Davis, M Cappell (2006)
              The aim of the study was to characterize the clinical presentation, evaluation, and therapy of Bouveret's syndrome, by comprehensively reviewing all the identified previously reported cases, to facilitate early diagnosis and thereby to improve the prognosis. Relevant articles were identified by MEDLINE computerized searches, by consultation with all available reference books, and by review of the first author's teaching files. A new case in which the diagnosis of Bouveret's syndrome was missed at esophagogastroduodenoscopy (EGD)--despite endoscopic findings of gastric outlet obstruction caused by a hard, nonfleshy, and convex pyloric mass--prompted this review. Review of 128 reported cases identified syndromic characteristics. Patients on average were 74.1 +/- 11.1 (SD) yr old. The female-to-male sex ratio was 1.86. Prominent symptoms were nausea and vomiting in 87%, abdominal pain in 71%, hematemesis in 15%, recent weight loss in 14%, and anorexia in 13% of patients. Prominent signs were abdominal tenderness in 44%, signs of dehydration in 31%, and abdominal distention in 26% of patients. Endoscopy revealed gastroduodenal obstruction in nearly all cases, but identified the obstructing stone in only 69%. Abdominal ultrasound or computerized tomography was diagnostic in about 60% of cases. The following endoscopic findings are suggestive of Bouveret's syndrome: a dilated stomach containing old digested food from gastrointestinal obstruction together with a hard and nonfleshy mass at the obstruction. These endoscopic findings, in the setting of the currently reported characteristic epidemiologic and clinical findings, should strongly suggest this syndrome. Abdominal ultrasound or computerized tomography is recommended to confirm and extend the endoscopic diagnosis.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Case Rep Gastroenterol
                Journal ID (iso-abbrev): Case Rep Gastroenterol
                Journal ID (publisher-id): CRG
                Title: Case Reports in Gastroenterology
                Publisher: S. Karger AG (Allschwilerstrasse 10, P.O. Box · Postfach · Case postale, CH–4009, Basel, Switzerland · Schweiz · Suisse, Phone: +41 61 306 11 11, Fax: +41 61 306 12 34, karger@karger.com )
                ISSN (Electronic): 1662-0631
                Publication date Collection: Jan-Apr 2022
                Publication date (Electronic): 7 April 2022
                Publication date PMC-release: 7 April 2022
                Volume: 16
                Issue: 1
                Pages: 247-251
                Affiliations
                [1] aGME, UHS Southern California MEC, Temecula Valley Hospital, Temecula, California, USA
                [2] bGastroenterology Faculty, Oceana Gastroenterology Associate, Corona Regional Hospital, Corona, California, USA
                [3] cGME, School of Medicine at Government Medical College, Patiala, India
                [4] dSurgical Faculty, University of California Riverside, Riverside, California, USA
                [5] eRiverside Community Hospital, Riverside, California, USA
                Author notes
                Article
                Publisher ID: crg-0016-0247
                DOI: 10.1159/000522251
                PMC ID: 9082138
                SO-VID: 5bf25454-ce76-4581-8e77-b820a244efa0
                Copyright © Copyright © 2022 by S. Karger AG, Basel
                License:

                This article is licensed under the Creative Commons Attribution-NonCommercial-4.0 International License (CC BY-NC) (http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.

                History
                Date received : 27 September 2021
                Date accepted : 7 January 2022
                Date: 2022
                Page count
                Figures: 3, References: 15, Pages: 5
                Categories
                Subject: Single Case

                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: gallstone ileus,gastric-outlet obstruction,cholecystitis,mirizzi,bouveret
                Data availability:
                ScienceOpen disciplines: Gastroenterology & Hepatology
                Keywords: gallstone ileus, gastric-outlet obstruction, cholecystitis, mirizzi, bouveret

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