EURORAD ESR

Case 14470

Unusual gastric outlet obstruction with cholecystoduodenal fistula: Bouveret´s Syndrome

Author(s)
Alvarez de Eulate García M.T, Sigüenza González R, Jiménez Cuenca M.I, González Fuentes S, Sánchez Ronco M, Galván Fernández J.

Hospital Clinico Universitario Valladolid;
Valladolid, Spain;
Email:teresaeulate@hotmail.com
 
Patient
female, 79 year(s)
 
 
  • Figure 1
    Pneumobilia. Abdominal CT. Axial and coronal postcontrast images
     

    Abdominal cross section CT showing air in the biliary tree. Nasogastric tube within the stomach.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Coronal CT scan showing pneumobilia with air within the choledochus.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;
     
     
  • Figure 2
    Abdominal CT. Axial, coronal and sagittal postcontrast images
     

    Axial scan of abdominal CT showing dilated stomach, a gallstone in the proximal duodenum with thickened duodenal wall, an adjacent contracted thick-walled gallbladder and cholecystoduodenal fistula.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Computer Applications-Detection, diagnosis; Special Focus: Obstruction / Occlusion;

    Enlarged image to appreciate the details.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Coronal CT image demonstrates air in the biliary tree (pneumobilia) and the fistulous communication between the gallbladder and the duodenum.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;

    Sagittal CT scan shows a gallstone within the duodenum isoattenuating to bile and fluid.

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;
     
     
  • Figure 3
    Endoscopic view of the obstructing gallstone.

    Upper gastrointestinal endoscopy. Darkly pigmented stone in the first part of the duodenum.

     
    Area of Interest: Abdomen; Imaging Technique: Percutaneous; Procedure: Endoscopy; Special Focus: Obstruction / Occlusion;
     
     
  • Figure 4
    Obstructing gallstone: intraoperative finding.

    Picture taken during surgery: obstructing gallstone.

     
    Area of Interest: Abdomen; Imaging Technique: Percutaneous; Procedure: Surgery; Special Focus: Obstruction / Occlusion;
     
     
Abdominal cross section CT showing air in the biliary tree. Nasogastric tube within the stomach.
 
Coronal CT scan showing pneumobilia with air within the choledochus.
 
Axial scan of abdominal CT showing dilated stomach, a gallstone in the proximal duodenum with thickened duodenal wall, an adjacent contracted thick-walled gallbladder and cholecystoduodenal fistula.
 
Enlarged image to appreciate the details.
 
Coronal CT image demonstrates air in the biliary tree (pneumobilia) and the fistulous communication between the gallbladder and the duodenum.
 
Sagittal CT scan shows a gallstone within the duodenum isoattenuating to bile and fluid.
 
Upper gastrointestinal endoscopy. Darkly pigmented stone in the first part of the duodenum.
 
Picture taken during surgery: obstructing gallstone.
 
 
 
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