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Delayed diagnosis of gastric outlet obstruction from bouveret syndrome in a young woman.

Smith Z, Totten J, Hughes A, Strote J - West J Emerg Med (2014)

Bottom Line: Bouveret syndrome is a rare presentation of gastric outlet obstruction caused by a gallstone in the proximal duodenum via a bilioenteric fistula.The clinical presentation is similar to that of a small bowel obstruction with abdominal pain, nausea and vomiting.We describe the case of a young woman with this condition who had a delayed diagnosis in part because of her age and the rarity of the condition.

View Article: PubMed Central - PubMed

Affiliation: Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington.

ABSTRACT
Bouveret syndrome is a rare presentation of gastric outlet obstruction caused by a gallstone in the proximal duodenum via a bilioenteric fistula. This is an infrequent although clinically significant cause of abdominal pain, almost exclusively in the elderly. The clinical presentation is similar to that of a small bowel obstruction with abdominal pain, nausea and vomiting. Surgery or endoscopy is often required for definitive diagnosis and therapy. We describe the case of a young woman with this condition who had a delayed diagnosis in part because of her age and the rarity of the condition.

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Transverse computed tomography of air passing from duodenum through a fistula into the gallbladder.
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f1-wjem-16-151: Transverse computed tomography of air passing from duodenum through a fistula into the gallbladder.

Mentions: Three days later, the patient returned to the ED. She reported worsening abdominal pain and increased nausea despite taking the prescribed medications. On exam, her vitals were still normal. She again demonstrated moderate right upper quadrant and mid-epigastric tenderness without distention, masses, Murphy’s sign, guarding, or rebound. The remainder of the examination was unchanged and normal. Laboratory studies revealed an AST of 252 units/L, ALT of 272 units/L, and alkaline phosphatase of 133 units/L. The patient’s urine pregnancy test, lipase, bilirubin, hematocrit, white blood count, electrolytes, renal function and coagulation function tests remained within normal limits. A computed tomography (CT) of the abdomen/pelvis was obtained and demonstrated mild thickening of the gallbladder wall, circumferential wall thickening and mucosal enhancement of the first part of the duodenum, with surrounding omental stranding and an associated visualized fistulous tract to the gallbladder. There were no gallstones identified in the bowel lumen and no clear evidence of gastric obstruction (Figure).


Delayed diagnosis of gastric outlet obstruction from bouveret syndrome in a young woman.

Smith Z, Totten J, Hughes A, Strote J - West J Emerg Med (2014)

Transverse computed tomography of air passing from duodenum through a fistula into the gallbladder.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4307701&req=5

f1-wjem-16-151: Transverse computed tomography of air passing from duodenum through a fistula into the gallbladder.
Mentions: Three days later, the patient returned to the ED. She reported worsening abdominal pain and increased nausea despite taking the prescribed medications. On exam, her vitals were still normal. She again demonstrated moderate right upper quadrant and mid-epigastric tenderness without distention, masses, Murphy’s sign, guarding, or rebound. The remainder of the examination was unchanged and normal. Laboratory studies revealed an AST of 252 units/L, ALT of 272 units/L, and alkaline phosphatase of 133 units/L. The patient’s urine pregnancy test, lipase, bilirubin, hematocrit, white blood count, electrolytes, renal function and coagulation function tests remained within normal limits. A computed tomography (CT) of the abdomen/pelvis was obtained and demonstrated mild thickening of the gallbladder wall, circumferential wall thickening and mucosal enhancement of the first part of the duodenum, with surrounding omental stranding and an associated visualized fistulous tract to the gallbladder. There were no gallstones identified in the bowel lumen and no clear evidence of gastric obstruction (Figure).

Bottom Line: Bouveret syndrome is a rare presentation of gastric outlet obstruction caused by a gallstone in the proximal duodenum via a bilioenteric fistula.The clinical presentation is similar to that of a small bowel obstruction with abdominal pain, nausea and vomiting.We describe the case of a young woman with this condition who had a delayed diagnosis in part because of her age and the rarity of the condition.

View Article: PubMed Central - PubMed

Affiliation: Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington.

ABSTRACT
Bouveret syndrome is a rare presentation of gastric outlet obstruction caused by a gallstone in the proximal duodenum via a bilioenteric fistula. This is an infrequent although clinically significant cause of abdominal pain, almost exclusively in the elderly. The clinical presentation is similar to that of a small bowel obstruction with abdominal pain, nausea and vomiting. Surgery or endoscopy is often required for definitive diagnosis and therapy. We describe the case of a young woman with this condition who had a delayed diagnosis in part because of her age and the rarity of the condition.

Show MeSH
Related in: MedlinePlus