Medicina Fluminensis, Vol. 57 No. 1, 2021.
Case report
https://doi.org/10.21860/medflum2021_365347
Bouveret's syndrome as a rare complication of cholecystolithiasis: case report
Lucia Klarica
orcid.org/0000-0003-0057-8470
; Sveučilište u Rijeci, Medicinski fakultet, Rijeka, Hrvatska
Harry Grbas
orcid.org/0000-0003-2962-6130
; Zavod za digestivnu kirurgiju, KBC Rijeka, Rijeka, Hrvatska
Abstract
Aim: To present a case of a patient with acute abdominal pain and Bouveret's syndrome as a rare complication of cholecystolithiasis. Case report: An eighty-year-old patient was admitted to the emergency department for upper abdominal pain and vomiting of dark content lasting three consecutive days. The patient had regular bowel movements, with normal stool and diuresis and normal body temperature. Laboratory findings showed slightly elevated values of inflammatory parameters. Abdominal ultrasound showed a crumpled gallbladder with gallstones. Radiographic tomography showed no signs of pneumoperitoneum and ileus.The patient was prescribed gastric antisecretory therapy with warning to come back if symptoms got worse. After two days the patient returned with more severe symptoms. An upper gastrointestinal (GI) endoscopy showed dark green content in the esophagus and stomach with a large gallstone obstructing the pylorus, which was the reason for admission. Another upper GI endoscopy was repeated on the next day, with the intent of gallstone extraction, but was not successful. On the third day of hospitalization, the patient underwent emergency exploratory laparoscopy, which was due to technical reasons converted to right subcostal laparotomy with gastrotomy in order to extract the gallstone. Furthermore, a gastroenteral and enteroenteral anastomosis according to the Brown method were constructed, a subhepatic drainage was put and the wound was sutured in layers. The postoperative course was complicated by a wound infection, which was successfully treated accordingly. The patient was discharged on the twenty-second postoperative day and had no biliary symptoms in the six-month follow-up period. Conclusion: Complications of cholecystolithiasis may also be the cause of acute abdominal pain. In rare cases, cholecystolithiasis can be complicated by gallstones presenting outside the gallbladder that migrate through the biliogastric or bilioduodenal fistula (Bouveret’s syndrome), which is a life-threatening condition with the mortality rate from 12% to 30%.
Keywords
abdominal pain; Bouveret’s syndrome; cholecystolithiasis; gallstones; gastric outlet obstruction
Hrčak ID:
251276
URI
Publication date:
1.3.2021.
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