1/30. duodenal obstruction by gallstone: case report of Bouveret's syndrome.Bouveret's syndrome involves gastric outlet obstruction by gallstone. Herein we describe an unusual case of duodenal bulb obstruction by gallstone. An 80-year-old woman was hospitalized with a fifteen-day history of vomiting. Computed tomography (CT) showed pneumobilia and a round calcified mass in the second portion of the duodenum. upper gastrointestinal tract series demonstrated the same sized oval radiolucency between the bulbus and the second portion of the duodenum. Endoscopic examination revealed a round black mass in the second portion of the duodenum, totally occupying the lumen. Endoscopic removal and destruction of the gallstone was attempted using a dye-laser, but the stone was too hard to crush. Eventually surgical enterolithotomy was successfully performed without cholecystectomy or closure of the fistula. Improved preoperative systemic management and prompt examination allowed earlier surgical intervention and reduced the morbidity. Surgical approach whether fistula closure should be performed remains controversial.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
2/30. Placement of Palmaz stents in malignant duodenal stenosis through a cutaneous fistula.This is the first report of palliative percutaneous treatment of a malignant duodenal stenosis due to cancer of the pancreatic head with Palmaz stents. A 65-year-old male with a malignant tumour of the pancreatic head developed an abscess with fistular communication to the cutis. In the subsequent course of the disease, tumour growth led to a severe duodenal stenosis. To dilate the tumorous stenosis, three Palmaz stents were introduced coaxially into the duodenum percutaneously, via the preexisting fistula. A technique to pass an almost 90 degrees kink is described. Symptomatic malignant duodenal stenosis was treated by insertion of three Palmaz stents. Due to their accurately controlled passive expansion at the level of the stenosis, and the resulting good adaptation to the individual anatomical situation, they were suitable for application in the duodenum.- - - - - - - - - - ranking = 3keywords = fistula (Clic here for more details about this article) |
3/30. Bouveret's syndrome complicated by acute pancreatitis.BACKGROUND/AIM: This study evaluated a case of Bouveret's syndrome due to a cholecystoduodenal fistula and gallstone obstruction of the duodenum, complicated by acute pancreatitis and cholecystitis. methods: The presenting features, special investigations, radiological findings, operative and endoscopic procedures were reviewed. RESULTS: Symptoms persisted after laparotomy and removal of a gallstone in the duodenum. Intra-operative endoscopy identified a second previously undetected stone impacted in the distal duodenum. CONCLUSION: The importance of excluding more than one stone causing Bouveret's syndrome is emphasized.- - - - - - - - - - ranking = 0.5keywords = fistula (Clic here for more details about this article) |
4/30. gastric outlet obstruction by a gallstone (Bouveret's syndrome).gastric outlet obstruction caused by a gallstone in the duodenum or pylorus(Bouveret's syndrome) is a very rare complication of gallstone disease. Presenting symptoms include epigastric pain, nausea, and vomiting. Preoperative diagnosis is not easy. Oral endoscopy is one of the diagnostic procedures. We present a case in which the diagnosis was made by endoscopic examination. Multiple attempts at endoscopic extraction of the gallstone from the duodenum were unsuccessful. A one-stage surgical procedure consisting of the removal of the impacted stone, fistula repair, and cholecystectomy was performed in this case. The postoperative course was uneventful.- - - - - - - - - - ranking = 0.5keywords = fistula (Clic here for more details about this article) |
5/30. Gallstone ileus as a complication of cholecystolithiasis.biliary fistula and gallston ileus are rarely found. The diagnosis is difficult. Gallstone ileus requires urgent and appropriate surgical therapy. Enterolitotomy remains the gold standard of operative treatment for gallstone ileus, but additional procedures of one-stage cholecystectomy and repair of fistula are necessary. Some researchers advise first to resolve the gallstone ileus and then to perform the elective operation for gallstone disease in more ideal circumstances. Our case had clinical evidence of ileus, which was confirmed by radiological exam. Ultrasonographic examination performed before operation did not confirm the presence of gallbladder; it did not detect a large stone located in the intestine. The patient, a 75-year-old woman, was operated on. During the procedure it was shown that the second part of the duodenum was involved in a scar and displaced to the hepatic hilus. There was no gallbladder; it was probably destroyed by a long-lasting vesicoduodenal fistula. cholangiography also did not detect the gallbladder. Biliary passage through the common bile duct was sufficient. The hole in the duodenum wall was sutured, and Kehr drain was inserted into the common bile duct. The gallstone was removed by incision of the intestine down to the obstruction. The postoperative period was complicated by a small suppuration of the laparotomy wound. Vesicoduodenal fistula present for a long time can lead to atrophy of the gallbladder. The one-stage procedure seems to be appropriate if biliary fistula and gallstone ileus are found.- - - - - - - - - - ranking = 2.5keywords = fistula (Clic here for more details about this article) |
6/30. Laparoscopic treatment of a gastric outlet obstruction caused by a gallstone (Bouveret's syndrome).Duodenal impaction of a gallstone after its migration through a cholecystoduodenal fistula is an uncommon cause of gallstone ileus described as Bouveret's syndrome. Surgical treatment is recommended, but the morbidity and mortality rates are nearly 60% and 30%, respectively. To reduce these rates using improved endoluminal surgery, a laparoscopically assisted intraluminal gastric surgery could be considered. A 74 year-old woman was admitted with typical Bouveret's syndrome. An intraluminal gastric laparoscopy was performed. The large stone impacted in the first duodenum was removed through the pylorus and pulled into the stomach. After its mechanical fragmentation, the stone was extracted with a sterile retriever bag through the main trocar. In the case of Bouveret's syndrome, treatment of the duodenal obstruction is mandatory. Surgical treatment of the cholecystoduodenal fistula still is controversial. We never perform a one-stage procedure, and we reserve a biliary operation for the patient who remains symptomatic. In this way, laparoscopically assisted intraluminal gastric surgery with transpyloric extraction of the stone can be a safe and interesting approach for this type of pathology.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
7/30. Bouveret's syndrome complicated by distal gallstone ileus after laser lithotropsy using holmium: YAG laser.BACKGROUND: Bouveret's syndrome is an unusual presentation of duodenal obstruction caused by the passage of a large gallstone through a cholecystoduodenal fistula. Endoscopic therapy has been used as first-line treatment, especially in patients with high surgical risk. CASE PRESENTATION: We report a 67-year-old woman who underwent an endoscopic attempt to fragment and retrieve a duodenal stone using a holmium: yttrium-aluminum-Garnet Laser (Ho:YAG) which resulted in small bowel obstruction. The patient successfully underwent enterolithotomy without cholecystectomy or closure of the fistula. CONCLUSION: We conclude that, distal gallstone obstruction, due to migration of partially fragmented stones, can occur as a possible complication of laser lithotripsy treatment of Bouveret's syndrome and might require urgent enterolithotomy.- - - - - - - - - - ranking = 1keywords = fistula (Clic here for more details about this article) |
8/30. Sonographic diagnosis of Bouveret's syndrome.A case of Bouveret's syndrome with obstruction of the duodenojejunal flexure diagnosed preoperatively by sonography is presented. A 48-year-old man with a history of cholelithiasis presented with colicky pain of 2 days' duration. Real-time sonography revealed a fluid-distended stomach and duodenum and a 3.4-cm bright curvilinear echo with dense shadowing in the duodenojejunal flexure, suggesting a gallstone. In addition, there was pneumobilia and evidence of chronic cholecystitis. The findings were confirmed with CT, which showed a partially calcified gallstone at the duodenojejunal flexure, pneumobilia, and a fistulous communication between the gallbladder and duodenum. At surgery, a large gallstone was found impacted at the duodenojejunal flexure. The stone and gallbladder were successfully removed and the fistula repaired. The sonographic diagnosis of Bouveret's syndrome enabled early surgical intervention.- - - - - - - - - - ranking = 0.5keywords = fistula (Clic here for more details about this article) |
9/30. Bouveret's syndrome: revisiting gallstone obstruction of the duodenum.Bouveret's syndrome is obstruction of the duodenum secondary to an impacted gallstone, usually without the presence of pneumobilia. With the steadily increasing life expectancy, greater numbers of these cases are being seen. gallstones enter the gastrointestinal tract following fistula formation between the gallbladder and an adjacent hollow viscus and may cause obstruction at any point along the intestinal tract. duodenal obstruction is the least common and represents only a very small percentage of cases. The presenting signs of nausea vomiting, abdominal cramping, and the absence of abdominal distension should alert the clinician to pathology in the proximal small bowel. The purpose of this report is to heighten the awareness of the primary care physicians, emergency room doctors, and surgeons to this diagnosis in elderly patients so that it can be included in the differential with the usual causes of gastric outlet obstruction--including ulcer disease; neoplasm; gastric volvulus; and other enteroliths, such as bezoars. early diagnosis is critical, as these cases require urgent surgical intervention. Early resuscitation, diagnosis, and treatment are essential for a successful outcome.- - - - - - - - - - ranking = 0.5keywords = fistula (Clic here for more details about this article) |
10/30. Characteristic findings for diagnosis of baby complicated with both the VACTERL association and duodenal atresia.The VACTERL [vertebral defects (V), anal atresia (A), cardiac anomaly (C), tracheal-esophageal fistula with esophageal atresia (TE), renal defects (R), and radial limb dysplasia (L)] association can sometimes be diagnosed by ultrasonography and magnetic resonance imaging (MRI). Although the preaxial limb anomalies on ultrasonography were strongly associated with VACTERL association, the rate of limb anomalies is low. On ultrasonography, useful findings for prenatal diagnosis are a combination of esophageal atresia with hydramnion and renal anomalies. If esophageal atresia cannot be detected due to masking, diagnosis may be very difficult. In this case report, we reported the VACTERL association along with duodenal atresia. The detection of characteristic findings (enlarged stomach and duodenum, possibly change in gallbladder) by use of ultrasonography and MRI might be useful for the prenatal diagnosis of such cases.- - - - - - - - - - ranking = 0.5keywords = fistula (Clic here for more details about this article) |
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