Bouveret's syndrome. An unusual localization of gallstone ileus.
This case report describes a 77-year-old male, who presented to the emergency room with symptoms of an acute proximal small bowel obstruction. Abdominal CT scan with multi-planar reconstructions led to the diagnosis of an intestinal obstruction due to impaction of a large gallstone in the second portion of the duodenum. The CT scan demonstrated a large cholecysto-duodenal fistula as the origin of the gallstone migration. Surgical treatment consisted of milking the stone down beyond the ligament of Treitz, where it was removed through a jejunal enterotomy. The postoperative course was uncomplicated. No attempt was made to repair the choledocho-duodenal fistula at the initial intervention nor subsequently, and there have been no complications due to the fistula over 36 months of follow-up observation.
Département des maladies de l'appareil digestif, groupe hospitalier Paris-Saint-Joseph, 185, rue R.-Losserand, 75014 Paris, France.
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Costil
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Jullès
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Loriau
D000368:Aged; D001658:Biliary Fistula / Q000150:complications / Q000000981:diagnostic imaging*; D004380:Duodenal Obstruction / Q000000981:diagnostic imaging / Q000209:etiology*; D005705:Gallbladder Diseases / Q000150:complications / Q000000981:diagnostic imaging; D042882:Gallstones / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications / Q000000981:diagnostic imaging*; D008297:Male; D013577:Syndrome; D014057:Tomography, X-Ray Computed