Bouveretâ•Žs Syndrome: Definitive Diagnosis with ...
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Lehigh Valley Health Network LVHN Scholarly Works Department of Medicine Bouveret’s Syndrome: Definitive Diagnosis with Esophagogastroduodenoscopy Patrick Hickey DO Lehigh Valley Health Network, [email protected] Mahew Sullivan DO Lehigh Valley Health Network, [email protected] Saba Ahmad MD Lehigh Valley Health Network, [email protected] James Cornell MD Lehigh Valley Health Network, [email protected] Shashin Shah MD Lehigh Valley Health Network, [email protected] See next page for additional authors Follow this and additional works at: hp://scholarlyworks.lvhn.org/medicine Part of the Medical Sciences Commons is Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by an authorized administrator. For more information, please contact [email protected]. Published In/Presented At Hickey, P., Sullivan, M., Ahmad, S., Cornell, J., Shah, S., & Shah, H. (2014, October 17). Bouveret’s Syndrome: Definitive Diagnosis with Esophagogastroduodenoscopy. Poster session presented at the American College of Gastroenterology Annual Scientific Meeting, Philadelphia, PA.
Transcript of Bouveretâ•Žs Syndrome: Definitive Diagnosis with ...
Lehigh Valley Health NetworkLVHN Scholarly Works
Department of Medicine
Bouveret’s Syndrome: Definitive Diagnosis withEsophagogastroduodenoscopyPatrick Hickey DOLehigh Valley Health Network, [email protected]
Matthew Sullivan DOLehigh Valley Health Network, [email protected]
Saba Ahmad MDLehigh Valley Health Network, [email protected]
James Cornell MDLehigh Valley Health Network, [email protected]
Shashin Shah MDLehigh Valley Health Network, [email protected]
See next page for additional authors
Follow this and additional works at: http://scholarlyworks.lvhn.org/medicine
Part of the Medical Sciences Commons
This Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact [email protected].
Published In/Presented AtHickey, P., Sullivan, M., Ahmad, S., Cornell, J., Shah, S., & Shah, H. (2014, October 17). Bouveret’s Syndrome: Definitive Diagnosis withEsophagogastroduodenoscopy. Poster session presented at the American College of Gastroenterology Annual Scientific Meeting,Philadelphia, PA.
AuthorsPatrick Hickey DO, Matthew Sullivan DO, Saba Ahmad MD, James Cornell MD, Shashin Shah MD, and HiralN. Shah MD
This poster is available at LVHN Scholarly Works: http://scholarlyworks.lvhn.org/medicine/834
© 2014 Lehigh Valley Health Network
References:1 CappellM,DavisM.CharacterizationofBouveret’ssyndrome:acomprehensive
reviewof128cases.The American Journal Of Gastroenterology[serialonline].September2006;101(9):2139-2146.
2 MavroeidisV,MatthioudakisD,EconomouN,KaranikasI.Bouveretsyndrome–therarestvariantofgallstoneileus:acasereportandliteraturereview.Case Reports in Surgery [serialonline].2013;2013:839370.
Background•Definition:Bouveret’ssyndromeisararevariantofgallstoneileuscharacterizedbyupperGI
obstructionfromanimpactedgallstoneinthesettingofbilioentericfistula•�Presentation:Elderlyfemaleswithnausea,vomiting,andupperabdominalpain•Diagnosis:Usuallymadewithimagingorendoscopy - Rigler’striadofgallstoneileusconsistsofasmallbowelobstruction,pneumobilia,andanectopicradiopaquegallstone
onx-ray
•Treatment:Commonlysurgicalremoval,butendoscopicextractionandlithotripsyhavebeendescribed
•WereportararecaseofBouveret’ssyndromeanddescribeitsendoscopicdiagnosisandsurgicalmanagement
Images
Discussion•FrenchinternistLeonBouveretfirstdescribedthesyndromein1896•Bouveret’ssyndromeisararedifferentialdiagnosisforuppergastrointestinal
obstructioninelderlypatients•Surgicalawarenessandpossibleinterventioniswarrantedinsuch
complicatedcases•Inthiscasewedemonstratethevalueofendoscopytodiagnoseandguide
thetreatmentofBouveret’ssyndromewithnon-diagnosticimaging
CTscanoftheabdomenandpelvisshowingapossiblecholecystoduodenalfistulawith
pneumobilia,possiblenonopaquegallstoneinthethirdportionoftheduodenum,andupper
gastrointestinalobstruction
Case�Presentation•An80year-old-femalepresentswithintractablenauseaandvomitingoftwodaysduration
associatedwithmildrightupperquadrantpain•CTScan: - Evidenceofapossiblecholecystoduodenalfistulawithpneumobilia - Possiblenon-opaquegallstonewithinthethirdportionoftheduodenum - Uppergastrointestinalobstruction
•EGDperformedfordefinitivediagnosisandattemptedtreatment: - Twolitersofbiliousfluidandgastriccontentswereremovedfromtheesophagusandstomach - Secondportionoftheduodenumhadgranulatedulcerationandpusconsistentwithcholecystoduodenalfistula - Distalthirdportionoftheduodenumrevealedcompletelumenobstructionwithamassofblack-and-whitematerial
composedofgallstonesanddebris - Theentiremasscouldnotbemobilizeddespiteeffortswithaneedleknifetobreakthestone
•Subsequentexploratorylaparotomyallowedsurgicalremovalofa5.5x3.5x3.5cmgallstonefromduodenotomysite
•Duringthesurgicalprocedurethefistulawasleftintactbecauseitwasscarredandnotwellvisualized
•Agastrojejunaltubewasplacedfortubefeedingsandshewasquicklyadvancedtoasoliddiet•Shewasdischargedhomeinstableandimprovedconditionaweekaftersurgicalintervention,and
continuestodowellinfollow-up
Abdominalx-rayshowingpneumobiliaandgastricoutletobstruction
EGD:Secondportionoftheduodenumshowinggranulatedulcerationandpusconsistentwith
cholecystoduodenalfistula
EGD:Distalthirdportionoftheduodenumshowingcompleteluminalobstructionbya
gallstoneanddebris
UpperGIseriespriortodischargeshowingdelayedgastricemptyingbutnoevidenceofsignificant
obstruction
Lehigh Valley Health Network, Allentown, PA
Bouveret’s Syndrome: Definitive Diagnosis with EsophagogastroduodenoscopyPatrick Hickey DO, Matthew Sullivan DO, Saba Ahmad MD, James Cornell MD, Shashin Shah MD and Hiral Shah MD
