Which is currently the first line of treatment of Bouveret syndrome?
A. Open surgery
B. Laparoscopic Surgery
C. Endoscopic intervention
D. Surgery if conservative management fails
Bouveret syndrome is the most infrequent variant of gallstone ileus.
Gastric outlet obstruction.
Bouveret syndrome is caused by a large stone passing through a bilioduodenal fistula causing gastric outlet obstruction.
Bouveret syndrome has a high mortality, estimated at 12 to 30%, because an elderly age group is usually afflicted, delay of diagnosis owing to its non-specific presentation and complexity of the disease.
Entry point of gall stone
Entry point is typically a fistula between the gallbladder and a portion of the stomach or intestine.
Rigler’s triad -Imaging
Pneumobilia, bowel obstruction, and an aberrant gallstone referred to as Rigler’s triad.
Rigler’s triad is highly suggestive of Bouveret syndrome.
Rigler’s triad – only found in 40% to 50% of cases.
Spontaneous resolution of Bouveret syndrome after conservative treatment is rare and a dislodged stone can cause distal obstruction.
First line of treatment
Endoscopic intervention is currently the first line of treatment of Bouveret syndrome.