ABSTRACT
Bouveret's syndrome is defined as gastric outlet obstruction secondary to an impacted gallstone in the duodenum via a cholecystoduodenal or cholecystogastric fistula. Common radiological findings include pneumobilia, calcified right upper quadrant mass, pyloric or duodenal obstruction and cholecystoduodenal fistula. Initial attempts through endoscopic retrieval may be successful; however, results can vary. Surgical options include enterolithotomy or gastrotomy with or without cholecystectomy and fistula repair. We describe a unique case of Bouveret's syndrome with short-lived obstruction followed by vomiting of gallstones in a morbidly obese patient and discuss the complexities of investigation and management of these patients.
Subject(s)
Gallstones , Gastric Outlet Obstruction/etiology , Intestinal Fistula/diagnosis , Vomiting/etiology , Diagnosis, Differential , Female , Gastric Outlet Obstruction/diagnosis , Humans , Middle Aged , Obesity, Morbid/complications , Tomography, X-Ray Computed , UltrasonographyABSTRACT
AIM: This study aims to determine the role of positron emission tomography (PET)/computed tomography (CT) in changing the management plan in patients with metastatic or recurrent colorectal cancer (CRC) and to evaluate the role of PET/CT in patients with an unexplained rise in carcinoembryonic antigen (CEA). MATERIALS AND METHODS: A total of 60 consecutive patients with CRC, who had PET/CT, were identified between 2008 and 2010. All patients had CT scans prior to the PET/CT. Data were collected from clinic letters, CT and PET CT reports and pathology results and cross-checked with the patient's notes. RESULTS: Patients were aged between 43 and 85 years [33 males, 27 females]. CEA was raised in 37 patients and normal in 23. Results of PET/CT were compared with that of CT scan and 33 out of the 60 patients (55%) had PET/CT results which were different to that of CT scan and 27 patients (45%) had similar PET/CT and CT results. PET scan appropriately altered the management in 23/60 patients (38%) and avoided unnecessary surgery in 14 patients. PET/CT had a sensitivity of 86% and specificity of 84%. In patients with an unexplained rise in CEA, PET/CT was positive in only one out of ten (10%) patients. CONCLUSION: PET/CT is valuable in deciding the management outcome in patients with metastatic or recurrent colorectal cancer. Unnecessary surgery might be avoided by careful use of PET/CT scanning in colorectal cancer patients. PET/CT might not be of value in patients with an unexplained rise in CEA.
