A Typical Case of Bouveret's Syndrome, or Not?

Gusta Van Zwieten, Eric B. De Goede, Ronald T. Van der Laan, Jeroen Heemskerk
2014 Journal of Gastrointestinal and Liver Diseases  
A 68-year-old obese woman (BMI 57kg/m 2 ) presented with continuous abdominal pain and extensive vomiting since ve days. Physical examination revealed sparse peristaltic sounds, abdominal tenderness but no muscular defense. Laboratory examination showed increased C-reactive protein (79 mg/L) and leucocytosis (17.5 x10 9 /L). Liver function tests were normal. CT scan demonstrated an air-fluid level inside the gallbladder (Fig. 1 , axial MDCT slice in late portal-venous phase) and a thickened
more » ... and a thickened gallbladder wall, which was not sharply delineated from the stomach wall ( Fig. 2 , coronal MDCT slice). ese ndings suggested stulisation from the gallbladder to the duodenum or stomach, presumably by a gallstone. Bowel obstruction could not be objectivated. Under the diagnosis of "Bouveret's syndrome", a gastroduodenoscopy was performed in order to con rm the diagnosis and clear the duodenum from possible gallstones. Surprisingly, gastroduodenoscopy did not show gallstones, but revealed a sharp piece of plastic, stuck in the antrum of the stomach. e prepyloric gastric wall showed edema and puss excretion from the perforation site (Fig. 3) . e foreign body could be removed successfully. A er one month of follow-up, the patient was completely recovered. She mentioned that she had probably ingested a plastic wrapping of a deep frozen pizza. Ingestion of a foreign body does not cause any symptoms in 80-90% of the cases. When symptoms arise they are usually secondary to obstruction or in ammation. Gastrointestinal perforation by ingested foreign bodies occurs in less than 1% of patients. Diagnosis is di cult due to multiple reasons. Patients are o en unaware of ingestion of a foreign body and the clinical
doi:10.15403/jgld-1272 fatcat:jze6ht4k7fhmrdsf7t5yadnble