Bouveret syndrome (clinical case)

Abstract

Gallstone disease is one of the most common surgical nosologies, which tends to increase steadily. More than 2.5 million cholecystectomy surgeries are performed annually in the world: in European countries – from 45 to 80 thousand, in the United States – more than 700 thousand choledocholithiasis with the development of mechanical jaundice. Diagnosis of these complications in most cases is not difficult, and the provision of surgical care is standardized. Bouvet’s syndrome (syn. Acute biliary ileus, Gallstone ileus) is a very rare complication of gallstone disease and is caused by the development of inflammatory degenerative-dystrophic changes between the gallbladder and the duodenal wall, leading to the formation of fistulas through which -intestinal tract with the development of obstruction. However, it should be noted that only in 7–10% of cases, the formed fistula can cause the migration of stones and the development of intestinal obstruction.

By 2008, only about 300 cases of the syndrome had been described in the world literature. Patients with a long history of stone disease, frequent episodes of exacerbation of cholelithiasis, female gender, old age are the main risk factors for Bouvere syndrome. Compared to other types of mechanical obstruction, the frequency of biliary ileus is only 1–4% and can reach 24% in people over 70 years. The complexity of the diagnosis is due to the nonspecificity of the initial manifestations, comorbidity of patients, late treatment. Postoperative mortality in acute calculous cholecystitis ranges from 0.28% to 3.01% (on average in Ukraine 0.94–0.81%), and in Bouvere syndrome can reach 24%. The main direct causes of death are bleeding, perforation, acute pancreatitis, severe dyselectrolyte disorders. The possibility of widespread use of computed tomography and magnetic resonance imaging greatly simplifies the diagnostic search. However, unfortunately, preoperative diagnosis of the syndrome is achieved only in a quarter of patients. Minimally invasive methods, given the growth of scientific publications and personal experience, can be successfully used to correct this pathology as a final method. A literature review of the etiology, pathogenesis, clinical manifestations, prevalence, methods of diagnosis and treatment of Bouvet syndrome is presented.

Clinical case (short description). Presented own clinical observation of Bouvere syndrome in a patient hospitalized in the surgical department of the KNP «Regional Clinical Hospital named after O.F. Gerbachevsky» with the phenomena of duodenal immobility and long history of stone-bearing. Consecutive use of endoscopic and instrumental imaging methods allowed accurate diagnosis, and the use of laparoscopic access made it possible to perform minimally invasive correction of pathology in this patient.

Conclusions. Gallstone disease is one of the most common surgical pathologies. Bouvere syndrome is a rare complication of the latter. Clinical symptoms are less specific, so the use of additional instrumental examinations allows accurate preoperative diagnosis. Due to the low efficiency of endoscopic methods of correction surgery is the main tool. The increase in scientific publications on the use of laparoscopic and video-assisting techniques makes it possible to argue about the relatively high efficiency of the latter in the correction of this pathology.

The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies.

The authors declare no conflicts of interests.