Rare presentation of gastric outlet obstruction with jejunal impaction of gall stones-the Bouveret’s syndrome
DOI:
https://doi.org/10.18203/2349-2902.isj20230989Keywords:
Gastric outlet obstruction, Bouveret’s syndrome, Rigler’s triadAbstract
Gall stones related complications are very common in the world, Bouveret’s syndrome is one of the rare complications (1-3%). Bouveret’s syndrome presents a diagnostic and therapeutic challenge. We present a rare case of an 80-year-old lady diagnosed with gastric outlet obstruction with jejunal impaction of gallstones, because of a gallstone impacted in the jejunum 50 cm from duodenojejunal flexure. The patient was operated on with enterotomy and retrieval of gall stones impacted in the jejunum, with roux en y gastrojejunostomy drainage procedure, the gastro-duodenal fistula was left in situ, because of high risk and unstable general condition of our patient intra-operatively. The patient had multiple pre-existing pre and peri-operative comorbidities, fortunately, our patient recovered and our patient was discharged on 21st postoperative days. Identifying Rigler’s triad symptoms is synonymous with diagnosing Bouveret’s syndrome. However, classical Rigler’s triad is present in only 40% of cases, hence alertness and a high degree of suspicion are required to differentiate Bouveret’s syndrome from other mechanical causes of gastric outlet obstruction. The atypical cases of Bouveret’s syndrome present a challenge to the surgeon for early diagnosis and therapeutic surgical management.
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References
Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6(2):172-87.
Adnan AI, Vaz OP, Lapsia S, Sultana A, Ahmed MA. Bouveret’s syndrome: a case series and literature review on a gallstone disease causing gastric outlet obstruction. Cureus. 2022;14(7):e27519.
Kalwaniya DS, Arya SV, Guha S, Kuppuswamy M, Chaggar JG, Ralte L, et al. A rare presentation of gastric outlet obstruction (GOO) - The Bouveret's syndrome. Ann Med Surg (Lond). 2015;4(1):67-71.
Kudaravalli P, Saleem SA, Goodman A, Pendela VS, Arif MO. Bouveret syndrome is a rare cause of gastric outlet obstruction. Baylor University Medical Center Proceedings. 2020;33(2):235-6.
Haddad FG, Mansour W, Deeb L. Bouveret's Syndrome: Literature Review. Cureus. 2018;10(3):e2299.
Rossi D, Khan U, McNatt S, Vaughan R. Bouveret syndrome: a case report. W V Med J. 2010;106(2):18-22.
Tanaja J, Lopez RA, Meer JM. Cholelithiasis. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2022.
Park JM, Kang CD, Kim JH, Lee SH, Nam SJ, Park SC, et al. Cholecystoduodenal fistula presenting with upper gastrointestinal bleeding: A case report. WJCC. 2021;9(2):410-5.
Jones MW, Gnanapandithan K, Panneerselvam D. Chronic Cholecystitis. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2022.
Caldwell KM, Lee SJ, Leggett PL, Bajwa KS, Mehta SS, Shah SK. Bouveret syndrome: current management strategies. Clin Exp Gastroenterol. 2018;11:69-75.
Nuño-Guzmán CM. Gallstone ileus, clinical presentation, diagnostic and treatment approach. WJGS. 2016;8(1):65.
Shah FA, Winkle SM, Truitt T, Guez G, Draper K. Bouveret syndrome: a rare form of gallstone ileus. Cureus. 2021;13(3):e14042.
Ravikumar R, Williams JG. The operative management of gallstone ileus. Annals. 2010;92(4):279-81.
Singh G, Merali N, Shirol S, Drymousis P, Singh S, Veeramootoo D. A case report and review of the literature of Bouveret syndrome. Annals. 2020;102(1):e15-9.
