Bouveret's syndrome presenting as upper gastrointestinal hemorrhage without hematemesis.
A 74-year-old woman with a recent diagnosis of peptic ulcer disease diagnosed by endoscopy after presentation with an episode of upper gastrointestinal bleeding returned 6 1/2 weeks later with a 5-day history of nausea and vomiting without associated symptoms. An ultrasound was nondiagnostic except for a large gallstone and a poorly visualized gallbladder. Repeat endoscopy revealed a hard mass that was presumed to have formed secondarily to an ulcer-induced stricture, and a 6-cm filling defect just proximal to the duodenal bulb was seen on a preoperative upper gastrointestinal series. At laparotomy the mass was actually a large gallstone and two smaller stones, which had eroded into and become impacted in the duodenal bulb creating a gastric outlet obstruction. The stones were extracted via a duodenotomy, and the remaining portion of the gallbladder was removed with repair of the cholecystoduodenal fistula. The patient was discharged home after an uncomplicated postoperative course. Gastric outlet obstruction by a duodenal gallstone is a condition known as Bouveret's syndrome, which is a rare complication of gallstone disease. Upper gastrointestinal hemorrhage is an especially rare form of presentation.
Jones
T A
TA
Department of Surgery, Easton Hospital, Pennsylvania 35234, USA.
Davis
M E
ME
Glantz
A I
AI
D000368:Aged; D002763:Cholecystectomy; D002769:Cholelithiasis / Q000150:complications* / Q000601:surgery; D004378:Duodenal Diseases / Q000209:etiology; D004381:Duodenal Ulcer / Q000150:complications*; D005260:Female; D017219:Gastric Outlet Obstruction / Q000150:complications / Q000209:etiology*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006396:Hematemesis; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology; D013577:Syndrome