Buoveret's Syndrome – Rapid sonographic and endoscopic diagnosis

Problemstellung: Duodenal obstruction due to biliary stones was first noted in 1896 by Buoveret. We describe a rapid diagnosic procedure in patients with gall stone induced obstruction of upper GI tract by ultrasound and upper GI endoscopy.

Methode: Patient 1: A 84 year old woman presented with vomiting for several days and epigastric pain. By sonography dilatation of both stomach and duodenum was found. Ileus-like dilatation of proximal jejunal loops could be followed up to an obstructing echogenic lesion. In bile ducts aerobilie was demonstrated, gall bladder showed aerobilie as well as gall stones. By upper GI endoscopy in the duodenal bulb perforation was demonstrated; by advancing the endoscope into the jejunum the obstructing bile stone could not be reached. The concrement was removed by laparotomy.

Patient 2: A 70 year old woman presented with upper abdominal pain and emesis. By sonography massive dilatation of stomach and duodenum was demonstrated. In projection of the gall bladder a fluid filled space with connection to the duodenum was demonstrated. The site of intestinal obstruction was sonographically not demonstrable. No aerobilie was found. Endoscopically in the duodenal bulb the site of perforation was demonstrable and at the duodeno- jejunal junction an obstructing gall stone was seen. Unfortunately, the impactation of the concrement was thouroughly impacted did not permit (mechanical) lithotripsy.

Ergebnisse: Ultrasound demonstration of obstruction of the upper GI tract together with aerobilie or other pathologic features of the gall bladder leads to the suspicion of Bouveret's syndrome which could be assured by upper GI endoscopy.

Schlussfolgerung: Scilled sonography and endoscopy allow for rapid diagnosis of Buoveret's syndrome in the emergency room and permit a rapid stratification of the patients for therapeutic interventions.