It is a particular form of biliary ileus, occurring in 3% of. Bouveret disease definition of bouveret disease by medical. The full text of this article is available in pdf format. Bouveret syndrome is a very rare form of gastric outlet obstruction following the passage of a gallstone from the gallbladder to the duodenum or pylorus through a bilioenteric fistula. However, this case serves as an example of the advancements made in the field of endoluminal lithotripsy and how a minimally invasive. The patient had an uneventful postoperative course and was discharged. Bouveret syndrome, gallstone ileus, cholecystoduodenal fistula, bowel obstruction, aerobilia. Paroxysmal tachycardia is a form of tachycardia which begins and ends in an acute or paroxysmal manner. In 1896 the french physician leon bouveret published two cases of gastric outlet obstruction due to. Bouveret syndrome is a rare clinical disease associated with high mortality, which requires a high index of clinical suspicion for timely diagnosis.
Bouveret syndrome is a gastric outlet obstruction produced by a gallstone impacted in the distal stomach or proximal duodenum. Successful endoscopic treatment of bouveret syndrome in a. It is a rapid heartbeat that originates neither from the atria nor the ventricles, but rather from a node responsible for the propagation of electrical impulses of the heart. Pdf bouveret syndrome is an uncommon complication of very common disease. The gallstone passes through a fistula between the gallbladder and adhered portion of gastrointestinal tract. The treatment of bouveret syndrome requires extraction of the identified.
Bouverets syndrome, or gastric outlet obstruction due to a gallstone. Bouveret syndrome ayca calbay, ahmet toksoy, omer faruk gemis, fatma tortum department of emergency, ataturk university, erzurum, turkey 1. Bouveret s syndrome is a rare disease entity manifested by the formation of a cholecystoduodenal or choledochoduodenal fistula with passage of a gallstone into the duodenal bulb and subsequent obstruction of the gastric outlet. References in the icd10cm index to diseases and injuries applicable to the clinical term hoffmannbouveret syndrome hoffmannbouveret syndrome i47.
An initial endoscopic approach to management is described. Gastric outlet obstruction secondary to an impacted duodenal gallstone, or bouveret syndrome, is a rare variant of gallstone ileus. Ugihpb surgery, westmead hospital, westmead, new south wales, australia. Gallstone ileus is a relatively rare pathology, most commonly obstructing the terminal ileum. Bouveret hoffmann syndrome, or paroxysmal tachycardia. This disambiguation page lists articles associated with the title bouveret syndrome. Dec 06, 2019 bouveret syndrome is a rare clinical disease associated with high mortality, which requires a high index of clinical suspicion for timely diagnosis. Bouveret syndrome is a rare cause of gastric outlet obstructions. Bouverets syndrome is an unusual presentation of duodenal obstruction that occurs when a large gallstone passes through a cholecystoduodenal fistula. The gallstone reaches the small bowel through a bilioenteric fistula as a consequence of chronic inflammation and adherence between the biliary. Bouveret introduced the term paroxysmal tachyardia in 1889. This sequela is caused by the passage of the gallstone via a bilioenteric fistula, resulting in an impacted gallstone in the duodenum or stomach. Herein we present a case of an elderly woman with an impacted gallstone in duodenum and discuss its management.
Bouveret syndrome refers to gastric outlet obstruction caused. A treatment algorithm for management of bourvet syndrome is. The least common site of obstruction is the proximal duodenum or pylorus causing gastric outlet obstruction, which is known as bouveret s syndrome. The common presentation of nonspecific symptoms contributes to the diagnostic uncertainty and delay, which is strongly associated with adverse outcomes. Bouverets syndrome is an uncommon complication of the very common problem of gallstone disease. Gallstone ileus occurs when a gallstone passes from a cholecystoduodenal fistula or a choledochoduodenal fistula into the gi tract and causes obstruction, usually at the ileocecal valve. To our knowledge our patient seems to be the oldest one. It was described by leon bouveret in 1896, 1 and occurs most commonly in elderly women with a mean age of 68. Treatment should be individualized according to the patients age, physical condition, and disease characteristics. Bouverets syndromeradiological findings world journal. It is known to occur in elderly women due to the high incidence of gallstones and can cause significant morbidity and mortality, especially in patients with multiple comorbidities 5. Bouverethoffmann syndrome information including symptoms, causes, diseases, symptoms, treatments, and other medical and health issues.
To access free multiple choice questions on this topic, click here. Bouverets syndrome refers to gastric outlet obstruction caused by the. The patient recovered well following surgery and has remained free of. Bouveret s syndrome, first described in 1896, is gastric obstruction by a gallstone following a cholecystoduodenal fistula.
Bouveret syndromethe rarest variant of gallstone ileus. Bouveret syndrome is a rare variant of gallstone ileus causing gastric outlet obstruction. Generally, 1% to 4% of intestinal obstruction are caused by gallstone ileus and, of these, 1% to 3% are caused by bouveret syndrome 3,4. Initial attempts at endoscopic retrieval with or without mechanical or extracorporeal lithotripsy should be performed as firstline treatment, though success rates with endoscopic. An early diagnosis of this condition is recommended, as its mortality rate remains as high as 12%, nevertheless. Bouverets syndrome is defined as gastric outlet obstruction caused by duodenal impaction of a large gallstone which passes into the duodenal bulb through a cholecystogastric or cholecystoduodenal.
Treatment strategy for management of bouveret syndrome hpb. Bouverets syndrome is a rare cause of proximal gallstone ileus with obstruction of duodenum or gastric outlet. Images in clinical medicine from the new england journal of medicine bouveret s syndrome. Bouverets syndrome is a rare entity with limited evidence to favor one approach to management over another. Bouveret syndrome is a very rare form of gallstone ileus and open surgical therapy is associated with high morbidity and mortality. We present a unique case of a 78yearold male complaining of right upper quadrant abdominal pain and who was found to have a gallstone in the proximal duodenum along with pneumobilia and cholecystoduodenal. Bouverets syndrome describes gastric outlet obstruction secondary to an impacted gallstone. Bouverets syndrome is a rare disease entity manifested by the formation of a cholecystoduodenal or choledochoduodenal fistula with passage of a gallstone into the duodenal bulb and subsequent obstruction of the gastric outlet. Oct 01, 2015 a challenging case of bouveret syndrome ashwini kumar, md robert j bowles, md, jose m martinez, md, alberto r iglesias, md. It consists of obstruction due to impaction of a gallstone in the duodenum, through a cholecystoduodenal fistula and belongs to the larger group of conditions called gallstone ileus which occur after the development of a fistula between the gallbladder and the gastrointestinal tract. Duodenal obstruction by a gallstone bouverets syndrome managed by endoscopic stone extraction. Hoffmannbouveret syndrome icd10cm index to diseases.
Bouveret syndrome, leading to gastric outlet obstruction and seen with an incidence of less than 1%, is a syndrome met particularly in elderly patients and developing as the result of cholecystoenteric fistula. We present the case of an 80yearold woman with multiple medical comorbidities who presented to our service with 2 weeks of abdominal pain and nausea. Bouveret disease bouveret syndrome paroxysmal supraventricular tachycardia. Paroxysmal tachycardia is a form of tachycardia which begins and ends in an acute or paroxysmal manner it is also known as bouveret hoffmann syndrome. Bouveret syndrome is a rare complication in which a gallstone impacts in the duodenum and cause a gastric outlet obstruction. Bouveret syndrome is a rare complication of cholelithiasis, with only 315 cases reported in the literature between 1967 and 2016.
Bilioenteric fistula cases are associated with cholelithiasis and are rarely associated with duodenal peptic ulcers. We report a case of an 87yearold female patient presented with 1 week history of vomiting whose plain radiograms showed ileus and pneumobilia. There are 0 terms under the parent term hoffmann bouveret syndrome in the icd10cm alphabetical index. Delayed diagnosis of gastric outlet obstruction from bouveret. It is known to occur in elderly women due to the high incidence of gallstones and can cause significant morbidity and.
Pdf bouveret syndrome is a very rare form of gastric outlet. Ct, mrcp, and gastroscopy are the most useful tools for diagnosing this syndrome. Diagnosis of gallstone ileus based on riglers triad includes bowel obstruction, pneumobilia, and an ectopic gallstone 6. Icd10cm alphabetical index hoffmann bouveret syndrome. Bouveret syndrome arc journal of clinical case reports.
Although gallbladder lithiasis is a common disease, however, a bouveret syndrome represents an uncomman. He reports a patient who presented with this syndrome and then vomited and ruptured his oesophagus boerhaaves syndrome bouveret to boerhaave. Since the first descriptions of this entity by beaussier in 1770 and. We report, as far as we know, the first case published of bouveret syndrome with free duodenal and vesicular perforation to. Discussion bouverets syndrome is a type of gallstone ileus in which the stone is lodged in the duodenum or the stomach. Bouveret syndrome is caused by a large stone passing through a. Initial attempts at endoscopic retrieval with or without mechanical or extracorporeal lithotripsy should be performed as firstline treatment, though success rates with endoscopic treatment. Bouveret s syndrome, or gastric outlet obstruction due to a gallstone. It is most common in elderly women and frequently requires endoscopic or surgical management. The first published report of bouveret s syndrome 1896 is attributed to leon bouveret who reported on two patients with this disease.
Bouverets syndrome is a rare cause of gastric outlet obstruction. Previous reports suggest only 10% success rates with endoscopic approaches. In 85% of patients with biliaryenteric fistula, the fistula communicates with the duodenum and the stones will pass spontaneously without causing bowel obstruction, whereas in 15% of patients, the clinical features of bowel obstruction. Introduction bouveret syndrome is a gastric outlet obstruction caused by impaction of a gallstone that passes through a cholecyst duodenal or cholecysto gastric fistula and gallstone ileus is a. The first published report of bouverets syndrome 1896 is attributed to leon bouveret who reported on two patients with this disease. Case report bouveret syndrome in an elderly female zvi h. Gallstone ileus bouverets syndrome gastric outlet obstruction. Since then, there have been several case reports of unique manifestations of bouveret s syndrome, as well as reports of novel endoscopic treatment modalities. Bouverets syndrome, first described in 1896, is gastric obstruction by a gallstone following a cholecystoduodenal fistula. Introduction bouveret syndrome is a gastric outlet obstruction caused by impaction of a gallstone that passes through a cholecyst duodenal or cholecysto gastric fistula and gallstone ileus is a rare complication of cholelithiasis. Gallstone ileus is uncommon itself, accounting for only 14% of intestinal obstructions and bouveret syndrome is seen in only % of gallstone ileus cases. Bouverets syndrome is more prevalent in the elderly and in females, with a reported median age of 74 years and a female to male ratio of 1. Bouveret syndrome, in contrast to gallstone ileus, is characterized by the cephalad or proximal migration of a gallstone into the duodenum resulting in a persistent gastric outlet obstruction as originally described by the french surgeon leon bouveret in 1896.
In this case, unsuccessful endoscopic treatment necessitated surgery for removal of impacted gallstone in the duodenum. A gastric outlet obstruction secondary to a gallstone ileus is known as bouveret syndrome. The symptomatology of patients with bouverets syndrome can be nonspecific, and physical signs may be consistent with those found in cases of gastric outlet obstruction. Bouveret syndrome is a rare complication of biliary lithiasis. The presenting clinical situation is variable and nonspecific but often includes nausea, vomiting, and epigastric pain. This is a case of a 59 year old female with bouverets syndrome. Bouverets syndrome is a type of gallstone ileus in which the stone is lodged in the duodenum or the stomach. In 1896, the first two cases of gastric outlet obstruction from an impacted gallstone were reported by leon bouveret 1,2.
The use of vaughan procedure in bouveret syndrome biomedres. A history of gallstone disease will only be present in a minority of patients 5. Endoscopic extraction is the preferred for the theraphy. Bouverethoffmann syndrome, or paroxysmal tachycardia.
Perry1,2, udit gibor1, shahar atias1, solly mizrahi1, alex. First case reported of bouverets syndrome associated to. Since then, there have been several case reports of unique manifestations of bouverets syndrome, as well as. Delay in diagnosis is associated with a high mortality rate. Bouveret syndrome, an extremely rare cause of gastric outlet obstruction, is characterized by the impaction of a gallstone, which has either passed into the duodenum or pyloric channel via a cholecystoduodenal or cholecystogastric fistula. Laboratory studies may reveal signs of dehydration if vomiting has been prolonged. Bouverets syndrome presenting with acute presentation of veryrare and challenging variant of gallstone ileus.
Bouveret syndrome occurs most commonly in elderly women. Bouveret s syndrome is defined as gastric outlet obstruction caused by duodenal impaction of a large gallstone which passes into the duodenal bulb through a cholecystogastric or cholecystoduodenal. Bouveret syndrome gastric outlet obstruction secondary to impaction of. Bouverets syndrome has the same pathophysiology as gallstone ileus, but instead of the ectopic gallstone causing obstructionileus in the distal small bowel most common terminal ileum in a rarer event the stone is lodged in the proximal duodenum or gastric pylorus causing gastric outlet obstruction, as in this case. Bouveret syndrome associated with acute gangrenous. The cause of this condition is not accurately known, though it is probably of nervous origin and can be aggravated by physical wear and tear. Bouveret syndrome refers to the condition of gastric outlet obstruction caused by the.
Images in clinical medicine from the new england journal of medicine bouverets syndrome. Different devices were used in attempts to free the stone from. The icd10cm alphabetical index is designed to allow medical coders to look up various medical terms and connect them with the appropriate icd codes. Endoscopy is the mainstay of diagnosis, but radiographic examination. Bouveret syndrome is a rare form of gallstone ileus caused by the passage and impaction of a large gallstone through a cholecystoduodenal fistula into the duodenum.
The condition sometimes complicates various heart diseases, occasionally occurring in apparently normal persons. Papers relating to bouverets syndrome presenting with duodenal obstruction were retrieved using boolean terms and, or with construction of filters. Hoffmannbouveret syndrome references in the icd10cm index to diseases and injuries. Palpitations and, less frequently, light headedness, shortness of breath, weakness, and polyuria are the typical symptoms. Bouveret syndrome is a rare presentation of gastric outlet obstruction caused by a gallstone in the proximal duodenum via a bilioenteric fistula. Definition paroxysmal tachycardia, or bouverethoffmann syndrome is a term used to refer to junctional tachycardia. Bouveret syndrome was first described in 1896 by french physician leon bouveret, and there were about 100 cases reported since then.
Multiple endoscopic modalities have been utilized for treatment of bouveret syndrome including endoscopic nets baskets,5 mechanical. It refers to gastric outlet due to proximal migration of gallstone through a cholecystoenteric fistula. A 96yearold woman was admitted to our department due to a gastric outlet obstruction. Bouverets syndrome on ct and radiography was repaired, and cholecystectomy was not performed during the surgery. Bouverets syndrome is defined as gastric outlet obstruction caused by duodenal impaction of a large gallstone which passes into the duodenal bulb through a cholecystogastric or cholecystoduodenal fistula. Bouveret syndrome represents 1%3% of cases of gallstone ileus. Cholecystoduodenal fistulas represent the most common type of bilioenteric fistulas while choledochoduodenal fistulas account for only 125% of cases. Here we present the first case of bouveret syndrome secondary to choledochoduodenal fistula complicating peptic.
Surgical duodenotomy following untreated bouveret syndrome. Delayed diagnosis of gastric outlet obstruction from. Diagnosis is based upon clinical manifestations, gastroscopy, and imaging studies such as abdominal computed tomography and magnetic resonance cholan. The clinical symptoms of bouveret s syndrome, such as nausea, vomiting, and epigastric abdominal pain, are nonspecific. Clinical presentation cholelithiasis is a relatively common health problem. We present a case report of a patient with bouveret syndrome with interesting radiological findings and successful surgical treatment after failure of the endoscopic techniques. Bouveret syndrome definition of bouveret syndrome by.
284 158 454 224 1420 1476 818 98 317 107 654 842 283 1571 245 1036 152 1152 1525 574 1137 1142 1191 950 582 1232 757 766 835 1171 909 217 105 1200 40 1148 21 1347 1021 1258 735 230 465 120 625 1413 79 1064