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Case Report
Bouveret’s syndrome: An unusual cause of gastric outlet obstruction
1 General Surgery Department, Hospital Santa Luzia Elvas, Unidade Local Saúde Norte Alentejano, Portugal
2 General Surgeon, General Surgery Department, Hospital Santa Luzia Elvas, Unidade Local Saúde Norte Alentejano, Portugal
3 Gastroenterologist, Special Exams Unit (Gastroenterology), Hospital Santa Luzia Elvas, Unidade Local Saúde Norte Alentejano, Portugal
4 Radiologist, Radiology Department, Hospital Santa Luzia Elvas, Unidade Local Saúde Norte Alentejano, Portugal
5 Internal Medicine, Internal Medicine Department, Hospital Santa Luzia Elvas, Unidade Local Saúde Norte Alentejano, Portugal
6 Head of Internal Medicine, Internal Medicine Department, Hospital Santa Luzia Elvas, Unidade Local Saúde Norte Alentejano, Portugal
7 Head of Surgery Department, General Surgery Department, Hospital Santa Luzia Elvas, Unidade Local Saúde Norte Alentejano, Portugal
Address correspondence to:
Marta Reia
General Surgery Department, Hospital Santa Luzia, Elvas - Unidade Local Saúde do Norte Alentejano, Av. Mariana Martins, 7350-954 Elvas,
Portugal
Message to Corresponding Author
Article ID: 100099Z06MR2021
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How to cite this article
Reia M, Messias F, Aguero C, Godinho R, Rodrigues T, Carvajal E, Cruz C, Urbano J, Silva V, Santos CP. Bouveret’s syndrome: An unusual cause of gastric outlet obstruction. Case Rep Int 2021;10:100099Z06MR2021.ABSTRACT
Introduction: Bouveret’s syndrome is a rare cause of pylorus or duodenal obstruction. This syndrome represents only 1–3% of all cases of gallstone ileus, more frequent in women and in the elderly. The clinical presentation is quite nonspecific, but in most cases the symptomatology suggests an upper digestive obstruction.
Case Report: We report a case of a 46-year-old man admitted with upper digestive obstruction due to a large biliary calculus that eroded through the gallbladder’s wall and pylorus, leading to digestive obstruction at this level. After attempted and unsuccessful endoscopic therapy, the patient was treated by surgery, with gastrotomy and gallstone removal. The fistula between the gallbladder and pylorus was not approached, because of the extent of the local inflammatory process, and elevated risk of complications.
Conclusion: Despite of being a benign disease, the morbidity and mortality of this syndrome may be elevated. The main objective of the treatment is to resolve the digestive obstruction, which can be achieved by upper gastrointestinal (GI) endoscopy, but most patients require a surgical approach. The treatment of the cholecystoduodenal/cholecystopyloric fistula—one-or two-stage treatment—is controversial, depending on the local inflammation, fibrosis, and anatomic distortion, as well the clinical condition of the patient.
Keywords: Bouveret’s syndrome, Duodenal obstruction, Gallstone ileus, Pylorus obstruction, Upper digestive obstruction
SUPPORTING INFORMATION
Author Contributions
Marta Reia - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Francisco Messias - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Coral Aguero - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Rogério Godinho - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Tiago Rodrigues - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Eduardo Carvajal - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Carlos Cruz - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Juan Urbano - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Victor Silva - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Carlos Penalva Santos - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Marta Reia et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
