Abstract
Case Presentation
Bouveret's syndrome is a rare variant of gallstone ileus resulting in gastroduodenal obstruction from an impacted gallstone. We report two cases of Bouveret's syndrome that were complicated by classic (distal) gallstone ileus, which has previously been reported only twice. The first patient presented with vomiting, epigastric pain, and what was initially believed to be a duodenal diverticulum on computed tomography scan and endoscopy. He initially improved, but later developed symptoms of a small bowel obstruction. Repeat imaging revealed a classic distal gallstone ileus. The second patient presented with nausea, abdominal pain, and imaging consistent with Bouveret's syndrome. Multiple non-operative endoscopic techniques and extracorporeal shock wave lithotripsy were employed to fragment and retrieve the obstructing stone, and she subsequently developed a distal gallstone ileus from a stone fragment. Both patients were managed operatively with enterotomy and stone removal.
Discussion
These cases highlight a rare complication of Bouveret's syndrome, classic (distal) gallstone ileus, and juxtapose the natural history of a stone passing versus an iatrogenic etiology. We review the presentation and management of Bouveret's syndrome though no clear consensus exists as to the optimal treatment of these patients. We recommend that therapy should be decided on a case-by-case basis.
Similar content being viewed by others
References
Lowe AS, Stephenson S, Kay CL, et al. Duodenal obstruction by gallstones (Bouveret's syndrome): a review of the literature. Endoscopy. 2005;37(1):82–7.
Clavien PA, Richon J, Burgan S, Rohner A. Gallstone ileus. Br J Surg. 1990;77(7):737–42.
Reisner RM, Cohen JR. Gallstone ileus: a review of 1001 reported cases. Am Surg. 1994 Jun;60(6):441–6.
Fancellu A, Niolu P, Scanu AM, et al. A rare variant of gallstone ileus: Bouveret's syndrome. J Gastrointest Surg. 2010;14(4):753–5.
Cappell MS, Davis M. Characterization of Bouveret's syndrome: a comprehensive review of 128 cases. Am J Gastroenterol. 2006;101:2139.
Gemmel C, Weickert U, Eickhoff A, et al. Successful treatment of gallstone ileus (Bouveret's syndrome) by using extracorporal shock wave lithotripsy and argon plasma coagulation. Gastrointest Endosc. 2007;65:173.
Sica GS, Sileri P, Gaspari AL. Laparoscopic treatment of Bouveret's syndrome presenting as acute pancreatitis. JSLS. 2005;9(4):472–5.
Gan S, Roy-Choudhury S, Agrawal S, Kumar H, Pallan A, Super P, Richardson M. More than meets the eye: subtle but important CT findings in Bouveret's syndrome. AJR Am J Roentgenol. 2008;191:182–185.
Lassandro F, Gagliardi N, Scuderi M, Pinto A, Gatta G, Mazzeo R. Gallstone ileus: analysis of radiological findings in 27 patients. Eur J Radiol. 2004;50:23–29
Kishi K, Yamada K, Sugiyama T. Gastric outlet obstruction caused by a large gallstone in the duodenum (Bouveret's syndrome). Clin Gastroenterol Hepatol. 2008;6:11.
Ferreira LE, Topazian MD, Baron TH. Bouveret's syndrome: diagnosis and endoscopic treatment. Clin Gastroenterol Hepatol. 2008;6:15.
Goldstein EB, Savel RH, Pachter HL, et al. Successful treatment of Bouveret syndrome using holmium:YAG laser lithotripsy. Am Surg. 2005;71(10):882–5.
Gencosmanoglu R, Inceoglu R, Baysal C, et al. Bouveret's syndrome complicated by a distal gallstone ileus. World J Gastroenterol. 2003 Dec;9(12):2873–5.
Puri V, Lee RW, Amirlak BA, et al. Bouveret syndrome and gallstone ileus. Surg Laparosc Endosc Percutan Tech. 2007 Aug;17(4):328–30.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Reinhardt, S.W., Jin, L.X., Pitt, S.C. et al. Bouveret's Syndrome Complicated by Classic Gallstone Ileus: Progression of Disease or Iatrogenic?. J Gastrointest Surg 17, 2020–2024 (2013). https://doi.org/10.1007/s11605-013-2301-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-013-2301-7