Bouveret syndrome

This article describes Bouveret's syndrome in gallstone disease. Bouveret syndrome is also a historical name for a form of tachycardia .

Bouveret syndrome on computed tomography.

The Bouveret syndrome (as the Mirizzi's syndrome ) is a rare complication of gallstone disease . A large gallstone migrates through an inflammatory connection ( fistula ) in the gallbladder into the duodenum and thus obstructs the gastric outlet. It is therefore a special form of the gallstone ileus .

Initial description

The clinical picture is named after the French doctor Léon Bouveret , who in 1896 described the classic case with a perforation of the gallbladder in the duodenal bulb with obstruction of the gastric outlet.

clinic

The patients (mostly women over 70 years of age) come with sudden abdominal discomfort, nausea and vomiting. Symptoms can be accompanied by a fever. Jaundice occurs less often . The symptoms are often not typical for gallstone disease, which in many cases was not yet known. Comorbidities often play a role in making the diagnosis more difficult. Overall, the clinical picture is acutely threatening for the patient and can even be fatal.

Diagnosis

Computed tomography coronally reconstructed: The firmly attached gallstone at the stomach outlet can be seen. Abundant fluids in the stomach. Air in the biliary tract.

Information on the cause of the symptoms can be found in the various imaging procedures. Usually an aerobia develops in the course of the fistula formation , which can be recognized in sonography as well as in computed tomography and occasionally in the X-ray overview. Together with the signs of a small intestinal ileus and evidence of a gallstone outside the gallbladder, one speaks of the Rigler triad typical of a gallstone ileus . In Bouveret's syndrome, however, the closure is so high directly at the gastric outlet that the signs of the small intestinal ileus may be absent. Signs of inflammation and possibly electrolyte shifts can be found in the laboratory.

therapy

Since the patients are often older people with concomitant diseases, a therapy approach that is as gentle as possible is to be preferred. If the clinical situation permits, an attempt to break up and remove the stone with the help of endoscopy is indicated. In many cases, however, especially when the diagnosis is not entirely certain, surgery is necessary. The main goal is to remove the stone and restore patency, as a major intervention involving removal of the gallbladder and closure of the fistula would increase the risk of the intervention.

literature

• Endoscopic images of Bouveret's syndrome. In: Journal for Gastroenterological and Hepatological Diseases , 2004; 2 (1), p. 44

Web links

Commons : CT and MRI image series of Bouveret's syndrome to flip through  - collection of images, videos and audio files

• Review article in Radiographics

Individual evidence

1. ↑ Léon Bouveret at whonamedit.com
2. ↑ L. Bouveret: Sténose de pylore adhèrent à la vesicule calceuse. In: Rev Med (Paris). 1896; 16, pp. 1-16.
3. ↑ M. Gajendran, T. Muniraj, A. Gelrud: A challenging case of gastric outlet obstruction (Bouveret's syndrome): a case report. In: Journal of medical case reports. Volume 5, 2011, p. 497, ISSN  1752-1947 . doi: 10.1186 / 1752-1947-5-497 . PMID 21970809 . PMC 3204302 (free full text).
4. ↑ R. Gencosmanoglu, R. Inceoglu, C. Baysal, S. Akansel, N. Tozun: Bouveret's syndrome complicated by a distal gallstone ileus. In: World journal of gastroenterology: WJG. Volume 9, Number 12, December 2003, pp. 2873-2875, ISSN  1007-9327 . PMID 14669357 .

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !