Bouveret syndrome
Updates to Article Attributes
Bouveret syndrome refers to a gastric outlet obstruction secondary to impaction of a gallstone in the pylorus or proximal duodenum. It is thereforeThus it can be considered a very proximal form of gallstone ileus.
Clinical presentation
Bouveret syndrome occurs most commonly in elderly women. The presenting clinical situation is variable and nonspecific but often includes nausea, vomiting, and epigastric pain. A history of gallstone disease will only be present in a minority of patients 5. Exemplifying reports of non-specific symptoms and comorbidities include synchronous acute diverticulitis 6 and complicating acute pancreatitis 7, just to name a few.
Radiographic features
Plain film and CT
Rigler triad (bowel obstruction, pneumobilia, and an ectopic gallstone) is seen only in a subset of patients. In cases where the offending gallstone is identified, its size (and hence the likelihood of mechanical obstruction) may be underestimated if only the calcified portion of the stone is measured 4.
Ultrasound
Sonography may detect the presence of a cholecystentericcholecystoenteric fistula, residual gallstones and gastric outlet obstruction.
Treatment and prognosis
Early diagnosis is important because mortality is high, with reported figures ranging between 12-33%.
Endoscopy is preferred as a therapeutic option because removal may be performed with mechanical, electrohydraulic, or laser lithotripsy.
Surgery often is not desirable as the patients are often poor surgical candidates secondary to concomitant illnesses and advanced age.
History and etymology
Named after Léon Bouveret, French internist (1850-1929).
Pearls and pitfallsPractical points
A preceding history of bilestonegallstone disease will only be present in a minority of cases 5-6.
-<p><strong>Bouveret syndrome</strong> refers to a <a href="/articles/gastric-outlet-obstruction">gastric outlet obstruction</a> secondary to impaction of a gallstone in the pylorus or proximal duodenum. It is therefore a very proximal form of <a href="/articles/gallstone-ileus">gallstone ileus</a>. </p><h4>Clinical presentation</h4><p>Bouveret syndrome occurs most commonly in elderly women. The presenting clinical situation is variable and nonspecific but often includes nausea, vomiting, and epigastric pain. A history of gallstone disease will only be present in a minority of patients <sup>5</sup>. Exemplifying reports of non-specific symptoms and comorbidities include synchronous acute diverticulitis <sup>6 </sup>and complicating acute pancreatitis <sup>7</sup>, just to name a few. </p><h4>Radiographic features</h4><h5>Plain film and CT</h5><p><a href="/articles/rigler-triad">Rigler triad</a> (bowel obstruction, <a href="/articles/pneumobilia">pneumobilia</a>, and an ectopic gallstone) is seen only in a subset of patients. In cases where the offending gallstone is identified, its size (and hence the likelihood of mechanical obstruction) may be underestimated if only the calcified portion of the stone is measured <sup>4</sup>.</p><h5>Ultrasound</h5><p>Sonography may detect the presence of a cholecystenteric fistula, residual gallstones and gastric outlet obstruction. </p><h4>Treatment and prognosis</h4><p>Early diagnosis is important because mortality is high, with reported figures ranging between 12-33%.</p><p>Endoscopy is preferred as a therapeutic option because removal may be performed with mechanical, electrohydraulic, or laser lithotripsy.</p><p>Surgery often is not desirable as the patients are often poor surgical candidates secondary to concomitant illnesses and advanced age.</p><h4>History and etymology</h4><p>Named after <strong>Léon Bouveret</strong>, French internist (1850-1929).</p><h4>Pearls and pitfalls</h4><p>A preceding history of bilestone disease will only be present in a minority of cases <sup>5-6</sup>. </p>- +<p><strong>Bouveret syndrome</strong> refers to a <a href="/articles/gastric-outlet-obstruction">gastric outlet obstruction</a> secondary to impaction of a gallstone in the pylorus or proximal <a title="Duodenum" href="/articles/duodenum">duodenum</a>. Thus it can be considered a very proximal form of <a href="/articles/gallstone-ileus">gallstone ileus</a>. </p><h4>Clinical presentation</h4><p>Bouveret syndrome occurs most commonly in elderly women. The presenting clinical situation is variable and nonspecific but often includes nausea, vomiting, and epigastric pain. A history of gallstone disease will only be present in a minority of patients <sup>5</sup>. Exemplifying reports of non-specific symptoms and comorbidities include synchronous acute diverticulitis <sup>6 </sup>and complicating acute pancreatitis <sup>7</sup>, just to name a few. </p><h4>Radiographic features</h4><h5>Plain film and CT</h5><p><a href="/articles/rigler-triad">Rigler triad</a> (bowel obstruction, <a href="/articles/pneumobilia">pneumobilia</a>, and an ectopic gallstone) is seen only in a subset of patients. In cases where the offending gallstone is identified, its size (and hence the likelihood of mechanical obstruction) may be underestimated if only the calcified portion of the stone is measured <sup>4</sup>.</p><h5>Ultrasound</h5><p>Sonography may detect the presence of a cholecystoenteric fistula, residual gallstones and gastric outlet obstruction. </p><h4>Treatment and prognosis</h4><p>Early diagnosis is important because mortality is high, with reported figures ranging between 12-33%.</p><p>Endoscopy is preferred as a therapeutic option because removal may be performed with mechanical, electrohydraulic, or laser lithotripsy.</p><p>Surgery often is not desirable as the patients are often poor surgical candidates secondary to concomitant illnesses and advanced age.</p><h4>History and etymology</h4><p>Named after <strong>Léon Bouveret</strong>, French internist (1850-1929).</p><h4>Practical points</h4><p>A preceding history of gallstone disease will only be present in a minority of cases <sup>5-6</sup>. </p>
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- Syndromes
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