Bouveretov sindrom kao rijetka komplikacija kolecistolitijaze
| Autor: | Lucia Klarica, Harry Grbas |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Abdominal pain
medicine.medical_specialty Bouveretov sindrom medicine.medical_treatment cholecystolithiasis Anastomosis BIOMEDICINE AND HEALTHCARE. Clinical Medical Sciences. Surgery Pneumoperitoneum abdominalni bol Bouveret’s syndrome Laparotomy kolecistolitijaza opstrukcija pilorusa žučni kamenci medicine medicine.diagnostic_test BIOMEDICINA I ZDRAVSTVO. Kliničke medicinske znanosti. Kirurgija business.industry Gallbladder abdominal pain Gastric outlet obstruction General Medicine Gallstones medicine.disease Endoscopy Surgery medicine.anatomical_structure gallstones gastric outlet obstruction medicine.symptom business |
| Zdroj: | Medicina Fluminensis Volume 57 Issue 1 |
| ISSN: | 1848-820X 1847-6864 |
| DOI: | 10.21860/medflum2021_365347 |
| Popis: | Cilj: Prikazati slučaj pacijentice s akutnim abdominalnim bolom i Bouveretovim sindromom kao rijetkom komplikacijom kolecistolitijaze. Prikaz slučaja: Osamdesetogodišnja pacijentica primljena je u hitnu medicinsku službu zbog bolova u epigastriju i gornjem abdomenu uz povraćanje tamnog sadržaja koji traju unazad tri dana. Posljednja stolica pacijentice bila je uredna, uredne diureze i pacijentica je bila afebrilna. U laboratorijskim nalazima vrijednosti upalnih parametara bile su neznatno povišene. Učinjen je ultrazvuk abdomena koji je pokazao skvrčeni žučnjak s kamencima. Nativna snimka abdomena nije pokazala znakove pneumoperitoneuma i ileusa. Pacijentici je ordinirana ulkusna terapija s naglaskom da se javi na kontrolni pregled ako se stanje pogorša. Dva dana nakon prijama pacijentici se stanje pogoršalo te dolazi u gastroenterološku ambulantu, gdje joj je učinjena ezofagogastroduodenoskopija (EGDS) koja je pokazala tamnozeleni sadržaj u lumenu jednjaka i želuca te zaglavljen velik kamenac u pilorusu, zbog čega je pacijentica hospitalizirana. Drugog dana hospitalizacije pacijentici se ponovio EGDS s neuspješnim ishodom. Trećeg dana hospitalizacije pacijentici je neuspješno učinjena hitna eksplorativna laparoskopija i operativni zahvat se konvertirao u desnu subkostalnu laparotomiju, te je gastrotomijom ekstrahiran žučni kamenac. Pacijentici je dalje učinjena gastroenteroanastomoza i enteroenteralna anastomoza po metodi Braun, uveden je dren subhepatalno i rana je zašivena po slojevima. Postoperativni tijek kompliciran je infekcijom operacijske rane. Pacijentica je otpuštena dvadesetdrugog postoperativnog dana te nije imala bilijarnih smetnji u sljedećih šest mjeseci praćenja. Zaključak: Uzrok akutnog abdominalnog bola nerijetko može biti i komplikacija kolecistolitijaze. U rijetkim slučajevima kolecistolitijaza se može komplicirati žučnim kamencem prisutnim izvan žučnjaka koji migirira kroz biliogastričnu ili bilioduodenalnu fistulu s opstrukcijom pilorusa (Bouveretov sindrom), što predstavlja životno ugrožavajuće stanje uz smrtnost od 12 % do 30 %. Aim: To present a case of a patient with acute abdominal pain and Bouveret's syndrome as a rare complication of cholecystolithiasis. Case report: An eighty-year-old patient was admitted to the emergency department for upper abdominal pain and vomiting of dark content lasting three consecutive days. The patient had regular bowel movements, with normal stool and diuresis and normal body temperature. Laboratory findings showed slightly elevated values of inflammatory parameters. Abdominal ultrasound showed a crumpled gallbladder with gallstones. Radiographic tomography showed no signs of pneumoperitoneum and ileus.The patient was prescribed gastric antisecretory therapy with warning to come back if symptoms got worse. After two days the patient returned with more severe symptoms. An upper gastrointestinal (GI) endoscopy showed dark green content in the esophagus and stomach with a large gallstone obstructing the pylorus, which was the reason for admission. Another upper GI endoscopy was repeated on the next day, with the intent of gallstone extraction, but was not successful. On the third day of hospitalization, the patient underwent emergency exploratory laparoscopy, which was due to technical reasons converted to right subcostal laparotomy with gastrotomy in order to extract the gallstone. Furthermore, a gastroenteral and enteroenteral anastomosis according to the Brown method were constructed, a subhepatic drainage was put and the wound was sutured in layers. The postoperative course was complicated by a wound infection, which was successfully treated accordingly. The patient was discharged on the twenty-second postoperative day and had no biliary symptoms in the six-month follow-up period. Conclusion: Complications of cholecystolithiasis may also be the cause of acute abdominal pain. In rare cases, cholecystolithiasis can be complicated by gallstones presenting outside the gallbladder that migrate through the biliogastric or bilioduodenal fistula (Bouveret’s syndrome), which is a life-threatening condition with the mortality rate from 12% to 30%. |
| Databáze: | OpenAIRE |
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