Bouveret’s Syndrome: A Case-Based Review, Clinical Presentation, Diagnostics and Treatment Approaches

Gastric outlet obstruction that arises from gallstones impacted in the distal stomach or proximal duodenum after passing through a cholecystoduodenal, cholecystogastric or rarely choledocoduodenal fistula is called as Bouveret's syndrome and it accounts for approximately 1-3% of all the patients with gallstone ileus. Although treatment modalities, including stone removal or fragmentation with classical endoscopic devices, such as snares, and forceps or fragmentation of gallstones with new devices, such as electrohydraulic lithotripsy, laser, extracorporeal shockwave lithotripsy have been described. However, only 29% of the patients benefit from nonsurgical methods. Removal of the stone through a gastrotomy or enterotomy and performing cholecystectomy and fistula repair with a second operation is an approach recommended for older patients with comorbid diseases. In this paper, a case of Bouveret’s syndrome was presented. The authors also aimed to review the diagnosis, management and treatment of this rare disease and to update the previous reviews.

Bouveret sendromu: Vaka temelli bir derleme; vaka sunumu, taný yöntemleri ve tedavi yaklaþýmlarý

Kolesistoduodenal, kolesistogastrik veya daha nadir olarak koledokoduodenal fistülden geçen safra taþýnýn mide distalinde veya proksimal duodenumda neden olduðu gastrik çýkýþ obstüksiyonu Bouveret sendromu olarak adlandýrýlýr. Bouveret sendromu safra taþý ileusu olan hastalarýn %1-3'ünde görülür. Her ne kadar elektrohidrolitotripsi, lazer, ekstrakorporeal þok dalgasý litotripsisi gibi yeni cihazlarla ve snare-forseps gibi klasik endoskopik cihazlarla safra taþlarýnýn çýkarýlmasý veya parçalanmasý gibi tedavi modaliteleri tanýmlanmýþsada, hastalarýn sadece %29'u cerrahi dýþý yöntemlerden yararlanmaktadýr. Taþýn gastrotomi veya enterotomi ile çýkarýlmasý ek olarak kolesistektomi yapýlmasý, ikinci bir operasyonla da fistül onarýmý yapýlmasý komorbid hastalýðý olan yaþlý hastalar için önerilen bir yaklaþýmdýr. Bu yazýda bir Bouveret sendromu vakasý sunulmuþtur. Yazarlar ayný zamanda bu nadir hastalýðýn taný ve tedavisini gözden geçirmeyi ve bu konu ile ilgili literatür bilgilerini derlemeyi amaçlamýþtýr. (SETB-2018-04-054)