Unusual Presentation of Bouveret Syndrome Resulting in Both Gastric Outlet Obstruction and Small Bowel Obstruction with Perforation

Our case describes an 83-year-old female who presented with severe abdominal pain, nausea, and bilious emesis of one day's duration. She had an endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and percutaneous transhepatic biliary drainage (PTCD) one year prior for chol...

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Bibliographic Details
Published in:Medicines (Basel, Switzerland) Switzerland), 2022-03, Vol.9 (3), p.24
Main Authors: Shelton, Jarod, Samad, Muhammad Adeel, Juhng, James, Terry, Shawn M
Format: Article
Language:English
Subjects:
Abdomen
Bouveret syndrome
Cardiovascular disease
Case Report
Cholecystectomy
choledochoduodenal fistula
Fistula
Gallbladder
Gallbladder diseases
gallstone
gallstone ileus
Gallstones
gastric gallstone ileus
Inflammation
Intestinal obstruction
Laparotomy
Mortality
Pain
Small intestine
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Summary:Our case describes an 83-year-old female who presented with severe abdominal pain, nausea, and bilious emesis of one day's duration. She had an endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and percutaneous transhepatic biliary drainage (PTCD) one year prior for choledocholithiasis with acute cholangitis in her home country, Scotland. Unfortunately, while visiting family in the United States, her PTCD became dislodged, and she developed progressive worsening abdominal pain. Computerized tomography of her abdomen showed pneumobilia, perigastric inflammation, a contracted gallbladder, small bowl inflammation with a likely transition point at the mid-jejunum, and a probable duodenal mass. The patient underwent an exploratory laparotomy with intraoperative findings of choledochoduodenal fistula with coincident gastric and small bowel obstruction (SBO) secondary to three large, mixed gallstones. One 3 cm gallstone was located at the pylorus and two (2.3 and 3 cm) gallstones were isolated in the mid-jejunum, with one of those causing isolated transmural pressure necrosis with subsequent perforation. Bouveret syndrome is a rare cause of gastric outlet obstruction (GOO) that manifests via an acquired cholecystoenteric fistula. Our patient presented with a concomitant GOO and SBO with perforation of the mid-jejunum. Timely diagnosis of Bouveret syndrome is essential, as most causes require emergent surgical intervention.
ISSN:2305-6320
2305-6320
DOI:10.3390/medicines9030024