The Use of Vaughan Procedure in Bouveret Syndrome
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 9, Issue 3
Abstract
Bouveret Syndrome is a rare complication in which a gallstone impacts in the duodenum and cause a gastric outlet obstruction. The gallstone passes through a fistula between the gallbladder and adhered portion of gastrointestinal tract. The formation of the fistula occurs after multiple episodes of cholecystitis. The impacted gallstone provoke gallbladder inflammation and pressure through the gallbladder wall causing erosion and allowing the stone to arrive to the duodenum. Gallstone ileus is responsible for 1-4% of all gastrointestinal obstruction and Bouveret Syndrome represents 2-3% of those cases [1]. The rarity of the syndrome can be explained by the fact that the majority of stones are small and doesn’t cause gastrointestinal obstruction. The stones that can cause obstruction are usually larger than 2 cm and 50 - 70% of gallstone impact in the ileum [2]. Bouveret Syndrome usually affects older women, and many have serious concomitant medical illnesses, including coronary disease, pulmonary disease, and diabetes mellitus that increases mortality and morbidity rates. The symptoms are vague and includes epigastric pain, nausea and vomiting. Less commonly, abdominal pain, distention, upper gastrointestinal bleeding, fever, weight loss and anorexia can be present [1].A 56 years old female patient, previously diagnosed with cholelithiasis, presented 7 days history with right hypochondrium pain, nausea and multiple vomiting episodes. The patient have been treated in another hospital where she underwent a abdominal Computed Tomography scanning. At the time she did not have the images nor the report. Although the patient referred better control of abdominal pain, she have had three episodes of vomiting on the day before. On physical examination the patient wan in bad condition, with mildly distended abdomen and pain on palpation of the right upper quadrant. Murphy sign was positive. Laboratory examination revealed a white blood cell count of 15.7 (x109/L), alkaline phosphatase 460 and (IU/L) and ɣGT 45 (UI/L). Onabdominal ultrasound the gallbladder was mildly distended, had a thick wall and multiple gallstones. No dilatation of the bile ducts was detected. Surgical treatment was decided.
Authors and Affiliations
Fernando Ponce Leon, Camila Nascimento Silva Barros de Oliveira, Gustavo Melo da Silva Silva, Márcio José Jamel, Viviane Leite Abud, Rodrigo Martinez
Keywords
Related Articles
- EP ID EP591766
- DOI 10.26717/BJSTR.2018.09.001808
- Views 148
- Downloads 0
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