ABSTRACT
INTRODUCTION: Bouveret's syndrome is characterized by piloro-duodenal obstruction following the implant of a giant gallstone with gallstone ileus origin. It constitutes the less common variety of gallstone ileus (1-3%), mainly affecting elderly patients with chronic degenerative illnesses, possibly with high mortality. OBJECTIVE: We report the case of a patient with a less common variety of gallstone ileus. The patient was treated at a third-level care hospital. CLINIC CASE: Patient is a 52-year-old male with gastric obstruction and secondary dehydration. Studies were supported by a series of esophagus-gastric-duodenal and broad endoscopy. Piloro-duodenal obstruction by a giant gallstone was reported which could not be extracted by endoscopy. The patient was taken to surgery where a giant gallstone lying in the duodenal site was found and biliary vesicular scleroatrophic. Gastrotomy is effected with the extraction of the gallstone and gastrography. Gallstone duodenal fistula is then identified with support analysis. CONCLUSIONS: Bouveret's syndrome is a rare entity whose diagnosis has a high sensitivity and specificity with a supported radiographic diagnosis. Endoscopy is difficult in the case of a giant impacted gallstone, making surgery the best therapeutic choice.
Subject(s)
Duodenal Obstruction/etiology , Gallstones/complications , Pylorus , Duodenal Obstruction/diagnosis , Duodenal Obstruction/surgery , Gallstones/diagnosis , Gallstones/surgery , Humans , Male , Middle Aged , SyndromeABSTRACT
Aproximadamente 75 por ciento de los divertículos duodenales yuxtapapilares (DDY) se localizan a 2 cm o menos del ámpula de Vater y se asocian con una elevada incidencia de cálculos vesiculares del colédoco, y a cuadros de pancreatitis recurrente. En un estudio ambipectivo y descriptivo que se realizó en un periodo de 8 años encontramos que de 680 colangiopancreatografías endoscópicas (CPE), 33 pacientes (4.8 por ciento) tiene DDY, la variedad más común fue localizado al borde de la papila en 15 pacientes (45.4 por ciento). El diagnóstico clínico de referencia más frecuente fue ictericia en 19 casos (57.5 por ciento) y cuadros sugestivos de pancreatitis en 11 casos (33.3 por ciento). El hallazgo endoscópico fue la colédocolitiasis en 14 casos (52.5 por ciento) y dilatación del conducto pancreático en 7 (21.2 por ciento). La primera se trato por vía endoscópica satisfactoriamente en 10 casos (30.3 por ciento)
