Bouveret syndrome
A rare
variant of gallstone ileus. Gastografin meal shows gastric dilatation with a complete gastric outlet obstruction and a intraluminal duodenal filling defect by gallstone impacted in duodenum.
Bouveret
syndrome • Bouveret syndrome - Ganzer Fall bei Radiopaedia
Rigler triad
(gallstone ileus) • Bouveret syndrome - Ganzer Fall bei Radiopaedia
Cholecystoduodenal
fistula with migrated gallstone leading to gastric outlet obstruction: Bouveret"s syndrome. Upper gastrointestinal series show a cholecystoduodenal fistula and partial filling of the gallbladder (open arrow). The filling defect in the gallbladder is caused by a gallstone (closed arrow).
This image
is part of a series which can be scrolled interactively with the mousewheel or mouse dragging. This is done by using Template:Imagestack. The series is found in the category Bouveret"s syndrome - CT - MRI - case 001. Bouveret-Syndrom in der Magnetresonanztomographie: Man erkennt den großen Gallenstein, der aus der Gallenblase in das Duodenum perforiert ist und jetzt den Magenausgang verlegt.
This image
is part of a series which can be scrolled interactively with the mousewheel or mouse dragging. This is done by using Template:Imagestack. The series is found in the category Bouveret"s syndrome - CT - MRI - case 001. Bouveret-Syndrom in der Magnetresonanztomographie: Man erkennt den großen Gallenstein, der aus der Gallenblase in das Duodenum perforiert ist und jetzt den Magenausgang verlegt.
Bouveret"s
syndrome complicated by distal gallstone ileus after laser lithotropsy using Holmium: YAG laser. 4 cm mass within the duodenum (gallstone) and adjacent gallbladder with air fluid level.
A challenging
case of gastric outlet obstruction (Bouveret"s syndrome): a case report. CT scan of the patient"s abdomen showing pneumobilia and a choledochoduodenal fistula.
A rare
variant of gallstone ileus. Abdominal radiogram showed a moderate gastric dilatation (asterisk), air in the biliary tract (arrows) and an ectopic large gallstone in the upper right abdominal quadrant mistaken for an orthotopic gallstone (red circle).
A rare
variant of gallstone ileus. Non-enhanced CT (axial view) shows a big calcified gallstone, wedged in the duodenum.
A rare
variant of gallstone ileus. Non-enhanced CT (coronal MPR image) shows gallstone, wedged in the duodenum and the bilio-duodenal fistula with gallblader filled with air.
A rare
variant of gallstone ileus. Non-enhanced CT (coronal MPR image magnified) shows a gas-filled fistulous connection between the gallbladder and the duodenum. (red arrow)
A rare
variant of gallstone ileus. Gastografin meal after surgery showed a large bilio-duodenal fistula and complete retrieval of the gastric-duodenal transit.
Bouveret
syndrome • Bouveret syndrome - Ganzer Fall bei Radiopaedia
This image
is part of a series which can be scrolled interactively with the mousewheel or mouse dragging. This is done by using Template:Imagestack. The series is found in the category Bouveret"s syndrome - CT - MRI - case 001. Bouveret-Syndrom in der Computertomographie: Man erkennt den großen Gallenstein, der aus der Gallenblase in das Duodenum perforiert ist und jetzt den Magenausgang verlegt. Der Magen ist stark gefüllt und eine Hiatushernie wölbt sich dadurch noch mehr nach oben.
This image
is part of a series which can be scrolled interactively with the mousewheel or mouse dragging. This is done by using Template:Imagestack. The series is found in the category Bouveret"s syndrome - CT - MRI - case 001. Bouveret-Syndrom in der Computertomographie: Man erkennt den großen Gallenstein, der aus der Gallenblase in das Duodenum perforiert ist und jetzt den Magenausgang verlegt. Der Magen ist stark gefüllt und eine Hiatushernie wölbt sich dadurch noch mehr nach oben.
Bouveret
syndrome • Bouveret syndrome - Ganzer Fall bei Radiopaedia
Unusual
gastric outlet obstruction with cholecystoduodenal fistula: Bouveret´s Syndrome. Upper gastrointestinal endoscopy. Darkly pigmented stone in the first part of the duodenum.
Unusual
gastric outlet obstruction with cholecystoduodenal fistula: Bouveret´s Syndrome. Axial scan of abdominal CT showing dilated stomach, a gallstone in the proximal duodenum with thickened duodenal wall, an adjacent contracted thick-walled gallbladder and cholecystoduodenal fistula.
Unusual
gastric outlet obstruction with cholecystoduodenal fistula: Bouveret´s Syndrome. Enlarged image to appreciate the details.
Unusual
gastric outlet obstruction with cholecystoduodenal fistula: Bouveret´s Syndrome. Coronal CT image demonstrates air in the biliary tree (pneumobilia) and the fistulous communication between the gallbladder and the duodenum.
Unusual
gastric outlet obstruction with cholecystoduodenal fistula: Bouveret´s Syndrome. Sagittal CT scan shows a gallstone within the duodenum isoattenuating to bile and fluid.
Unusual
gastric outlet obstruction with cholecystoduodenal fistula: Bouveret´s Syndrome. Abdominal cross section CT showing air in the biliary tree. Nasogastric tube within the stomach.
Unusual
gastric outlet obstruction with cholecystoduodenal fistula: Bouveret´s Syndrome. Coronal CT scan showing pneumobilia with air within the choledochus.
Cholecystoduodenal
fistula with migrated gallstone leading to gastric outlet obstruction: Bouveret"s syndrome. Contrast-enhanced axial CT image shows subtle gastric distention secondary to impaction of a gallstone in proximal duodenum. A stone is noted in the neck (open arrow), and in the body of the gallbladder (closed arrow).
Cholecystoduodenal
fistula with migrated gallstone leading to gastric outlet obstruction: Bouveret"s syndrome. Contrast-enhanced CT image obtained caudal to A shows pneumobilia in a partially contracted gallbladder. The gallbladder seems to communicate directly with adjacent duodenum and a large laminated gallstone is abutting the duodenal bulb (arrow).
Cholecystoduodenal
fistula with migrated gallstone leading to gastric outlet obstruction: Bouveret"s syndrome. Contrast-enhanced oblique reformatted CT image shows stone in the neck (small open arrow) and body (large open arrow) of the gallbladder. Adjacent a cholecystoduodenal fistula with stone migration into the duodenum is noted (closed arrow).
Cholecystoduodenal
fistula with migrated gallstone leading to gastric outlet obstruction: Bouveret"s syndrome. Upper gastrointestinal series show a large stone surrounded by contrast agent in duodenal bulb, resulting in partial gastric outlet obstruction (arrow).
Bouveret
syndrome • Bouveret syndrome - Ganzer Fall bei Radiopaedia
Bouveret
syndrome • Bouveret syndrome - Ganzer Fall bei Radiopaedia
Bouveret syndrome refers to a gastric outlet obstruction secondary to impaction of a gallstone in the pylorus or proximal duodenum. Thus, it can be considered a very proximal form of gallstone ileus.
Clinical presentation
Bouveret syndrome occurs most commonly in elderly women. The presenting clinical situation is variable and non-specific but often includes nausea, vomiting, and epigastric pain. A history of gallstone disease will only be present in a minority of patients . Exemplifying reports of non-specific symptoms and comorbidities include synchronous acute diverticulitis and complicating acute pancreatitis , just to name a few.
Radiographic features
Plain radiograph and CT
Rigler triad (bowel obstruction, pneumobilia, and an ectopic gallstone) is seen only in a subset of patients. In cases where the offending gallstone is identified, its size (and hence the likelihood of mechanical obstruction) may be underestimated if only the calcified portion of the stone is measured .
Ultrasound
Sonography may detect the presence of a cholecystoenteric fistula, residual gallstones and gastric outlet obstruction.
Treatment and prognosis
Early diagnosis is important because mortality is high, with reported figures ranging between 12-33%.
Endoscopy is preferred as a therapeutic option because removal may be performed with mechanical, electrohydraulic, or laser lithotripsy.
Surgery often is not desirable as the patients are often poor surgical candidates secondary to concomitant illnesses and advanced age.
History and etymology
Named after Léon August Bouveret, French internist (1850-1929) , the sign was originally described by him in 1896. However, it was actually originally described by Beaussier in 1770 .
Practical points
- a preceding history of gallstone disease will only be present in a minority of cases
Siehe auch:
- Aerobilie
- Gallensteinileus
- Magenausgangsstenose
- Rigler-Trias bei Gallensteinileus
- Cholezystoduodenale Fistel
- duodenobiliäre Fistel
- gastroduodenale Invagination
- enterobiläre Fistel
- duodenale Invagination
und weiter:
Assoziationen und Differentialdiagnosen zu Bouveret-Syndrom:
