Bouveret syndrome

The Bouveret syndrome is ( as the Mirizzi syndrome) is a rare complication of gallstone disease. Here, a large gallstone migrated through a flammable compound formed ( fistula ) of the gallbladder into the duodenum and so laid the pylorus. This is therefore a special form of gallstone ileus.

First description

The disease is named after the French physician Leon Bouveret, its the classic case described in 1896 with a perforation of the gallbladder into the duodenal bulb with relocation of the gastric outlet.

Clinic

The patients (mostly women over 70 years old) come with sudden abdominal pain, nausea and vomiting. The symptoms may be accompanied by fever. More rarely occurs jaundice. The clinical picture is often not typical of a gallstone disease, which was not yet known in many cases. Often play an aggravating comorbidities for a diagnosis role. Overall, the clinical picture for the patient is acutely threatening and can even be fatal.

Diagnostics

Clues to the cause of the complaints can be found in the various imaging techniques. Most developed within the framework of a fistula aerobilia that is visible both in sonography as well as in computed tomography and occasionally even in the X-ray radiograph. Along with the character of a small bowel obstruction and the detection of a gallstone outside the gallbladder is called typical of a gallstone Rigler 's triad. When Bouveret 's syndrome, however, the closure is so high directly at the pylorus, that the signs of small bowel obstruction may be absent. In the laboratory, there are signs of inflammation and possibly electrolyte shifts.

Therapy

Since it is often the case of older people with comorbidities in the patients a gentle as possible therapeutic approach is preferable. If permitted by the clinical situation, therefore, an attempt by the destruction and removal of the stone is displayed by using the endoscopy. In many cases, especially if the diagnosis is not quite sure yet, but will require surgery. It stands as a goal the removal of the stone with a restoration of patency in the foreground, because a larger intervention would with gallbladder removal and closure of the fistula increase the risk of surgery.