RESUMO
Bouveret's syndrome is a rare cause of intestinal obstruction caused by gallstones and is usually seen in older patients with poor medical status. The surgical treatment for these patients is controversial. The authors present a case of a 73-year-old woman who presented with coffee ground vomiting. An upper gastrointestinal endoscopy showed a big gallstone obstructing the duodenal bulb and a CT scan showed a cholecystoduodenal fistula. The stone could not be removed or crushed endoscopically and a laparotomy was undertaken to relieve the obstruction. The stone was removed by gastrotomy and a delayed cholecystectomy was not offered due to her co-morbid conditions. She presented 18 months later with pancreatitis and has now been offered an elective cholecystectomy.
Assuntos
Colecistectomia , Duodenopatias/cirurgia , Cálculos Biliares/cirurgia , Obstrução Intestinal/cirurgia , Idoso , Feminino , Humanos , SíndromeRESUMO
Although uncommon, jejunoileal diverticula are associated with significant morbidity and mortality. Both acute and chronic symptoms can be varied and non-specific, making jejunoileal diverticular disease a diagnostic and therapeutic challenge. We report a case of jejunal diverticular disease, complicated by acute diverticulitis, in a 75-year-old male who was successfully treated with conservative approach. The non-surgical approach was enabled by early assessment with multislice CT and active close observation.