Bouveret’s syndrome - 22/08/11
Doi : 10.1016/j.gie.2006.06.054
Lawrence J. Brandt, MD,Editor, At the Focal Point Section
| Commentary In 1896, Leon Bouveret described 2 patients with gastric outlet obstruction produced by a large gallstone impacted in the distal stomach/proximal duodenum. The proximate cause of this obstruction is a fistula, which develops after the inflamed gallbladder becomes adherent to its common anatomic resting place, the superior portion of the postbulbar duodenum. As if gastric outlet obstruction weren’t enough, vomiting can trigger Boerhaave’s syndrome, and fragmentation of the stone can be complicated by gallstone ileus. Because the impacted stone usually is very large, therapy can be both challenging and frustrating. Stone extraction with a basket or net or lithotripsy has been used, but surgery is often, as in the present case, required; in such cases, surgical extirpation of the stone should not be viewed as an endoscopic failure, but rather as prudent judgment. What should be done with the gallstone after removing it? Most of us send it, along with the gallbladder, to surgical pathology for processing. It might be useful to know, however, that gallstones are a valuable byproduct of meat processing and have fetched (illegally) up to $900 US an ounce for use as an aphrodisiac. Alas, the finest gallstones are not from humans but from old dairy cows. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2007
American Society for Gastrointestinal Endoscopy. Pubblicato da Elsevier Masson SAS. Tutti i diritti riservati.
Vol 65 - N° 4
P. 703-704 - aprile 2007 Ritorno al numero
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