Novosti
Khirurgii

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Year 2016 Vol. 24 No 5

CASE REPORTS

Z.S. FAIZIEV1, T.G. GULMURADOV1, E.L. KALMYKOV1,2, H.Z. FAIZIEV3, H.S. MUKHAMADIEVA1

A RARE CASE OF SURGICAL TREATMENT OF FEMALE PATIENT WITH BOUVERET SYNDROME

Republican Scientific Center of Cardiovascular Surgery1,
Tajik National Research Center for transplantation of organs and human tissue2,
Avicenna Tajik State Medical University3,
Dushanbe,
The Republic of Tadzhikistan

Bouveret’s syndrome is characterized by gastric outlet obstruction due to a gallstone in the duodenum, usually in association with a cholecystoduodenal fistula and occurs in 0.3-0.5% cases of gallstone complications. The purpose of this article is to demonstrate a rare presentation of gastric outlet obstruction caused by a gallstone. During the ultrasound study the hyperechoic formation with clear contours intensive acoustic track (dimensions 4,5×3,2 cm) below the projection of the gallbladder was visualized. The diameter of the duct of Wirsung averaged 3 mm. Sonographic signs in portal hypertension were not observed. The presence of calculus (sized 4,5×3,2 cm) occupying the entire lumen of the duodenal bulb and vesico-duodenal fistula was diagnosed during endoscopy and radiologic examination. The attempts to remove the stone endoscopically failed due to the large diameter. It was therefore decided to perform an open surgery. Laparotomy and gastrotomy on the border of gastric antrum and the stomach body extending 3,5 cm. were performed; a huge gallstone was extracted. Taking into consideration a severe infiltration of hepatoduodenal region with the involvement of the hepatic angle of the transverse colon and omentum as well as the risk of possible conflict with vascular secretory pedicle of hepatic gate, the removal of the biliary fistula with cholecystectomy was not carried out. The insicional period proceeded without any complications. Within 5 months of observation the patient’s condition was satisfactory, the complaints were not registered.

Keywords: Bouveret syndrome, gastric outlet obstruction, gall bladder, stone, fistula, cholecystectomy, complaints
p. 508-512 of the original issue
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Address for correspondence:
734000, Republic of Tajikistan,
Dushanbe, Mayakovsky st., 2,
Tajik National Research Center for transplantation of organs and human tissue,
of the Health Ministry of Human
and Social Protection, the Republic of Tajikistan.
Tel: +992 90 811 00 18
E-mail. egan0428@mail.ru
Kalmykov Egan Leonidovich
Information about the authors:
Faiziev Z.S. PhD, Leading Researcher of Republican Scientific Center of Cardiovascular Surgery of the Ministry of Health and Social Protection of Population of the Republic of Tadzhikistan.
Gulmuradov T.G. MD, Professor, Corresponding member of Academy of Science, Head of department of cardiovascular surgery of Tajik Institute of Postgraduate Medical Training,
Kalmykov E.L. PhD, Deputy Director (Science) of Tajik National Research Center for Transplantation Organ and Human Tissues of the Ministry of Health and Social Protection of Population of the Republic of Tadzhikistan.
Faiziev H.Z. Post-graduate student of department N2 of surgical diseases, Avicenna Tajik State Medical University.
Mukhamadieva H.S. Radiologist, Republican Scientific Center of Cardiovascular Surgery of the Ministry of Health and Social Protection of Population of the Republic of Tadzhikistan.
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