[Sonographic diagnosis of Bouveret's syndrome].
METHODS
A 76-year-old woman with known dementia was admitted to hospital for postprandial vomiting and increasing upper abdominal pain for 2 days. Gallstones and a chronic cholecystitis had been previously documented.


METHODS
Laboratory tests revealed slight hypochromic anemia (Hb 10.6 g/dl) and an increase in gammaGT (439 U/l) and AP (277 U/l) with a normal bilirubin. The gall bladder was very small sonographically, compared to an examination 6 months earlier. Furthermore, there was a marked aerobilia in the peripheral bile ducts.


METHODS
Bouveret;s syndrome, with a 6 cm concrement in the duodenal bulb, was suspected at the initial ultrasound examination and confirmed by endoscopy and radiology. TREATMENT AND FOLLOW-UP: When the patient was operated the following day, a chronically inflamed gall bladder with perforation into the duodenum was found, but no concrement in the duodenal bulb. The operative field was extended and revealed a distal small bowel obstruction caused by an incarcerated stone at the ileocecal valve. The concrement was removed and a cholecystectomy with closure of the fistula performed. However, 8 days later the patient died from multiorgan failure.


CONCLUSIONS
This was a rare case of a "classical" Bouveret's syndrome that spontaneously changed into a distal small bowel obstruction by gall stones. In an appropriate clinical setting, this condition can be diagnosed by a simple abdominal ultrasound examination.
Guntau
J
J
2. Medizinische Klinik, Albertinenkrankenhaus Hamburg.
Oelckers
M
M
Rathgeber
T
T
Lock
G
G
D000368:Aged; D001658:Biliary Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D002763:Cholecystectomy / Q000379:methods; D003937:Diagnosis, Differential; D004378:Duodenal Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D004380:Duodenal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D004384:Duodenoscopy / Q000379:methods; D017809:Fatal Outcome; D005260:Female; D005705:Gallbladder Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D042882:Gallstones / Q000150:complications* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D007077:Ileal Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D007080:Ileocecal Valve; D007412:Intestinal Fistula / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D009102:Multiple Organ Failure; D013577:Syndrome; D014463:Ultrasonography