EURORAD ESR

Case 14613

Cholecystoduodenal fistula with migrated gallstone leading to gastric outlet obstruction: Bouveret's syndrome

Author(s)
Eva De Backer1, Filip Vanhoenacker 2, 3, 4, Adelard De Backer5

1: Ghent University, Medical Student, De Pintelaan 185, 9000 Ghent, Belgium

2: AZ Sint-Maarten Duffel-Mechelen, Department of Radiology, Leopoldstraat 2, 2800 Mechelen, Belgium

3: Ghent University Hospital, Department of Radiology, De Pintelaan 185, 9000 Ghent, Belgium

4: Antwerp University Hospital, Department of Radiology, Wilrijkstraat 10, 2650 Edegem, Belgium

5: General Hospital Sint-Lucas, Department of Radiology, Groenebriel 1, 9000 Ghent, Belgium
 
Patient
female, 85 year(s)
 
 
  • Figure 1
    Computed tomography image showing Rigler’s triad
     

    Contrast-enhanced axial CT image shows subtle gastric distention secondary to impaction of a gallstone in proximal duodenum. A stone is noted in the neck (open arrow), and in the body of the gallbladder (closed arrow).

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

    Contrast-enhanced CT image obtained caudal to A shows pneumobilia in a partially contracted gallbladder. The gallbladder seems to communicate directly with adjacent duodenum and a large laminated gallstone is abutting...

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

    Contrast-enhanced oblique reformatted CT image shows stone in the neck (small open arrow) and body (large open arrow) of the gallbladder. Adjacent a cholecystoduodenal fistula with stone migration into the duodenum is...

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;
     
     
  • Figure 2
    Upper gastrointestinal series.
     

    Upper gastrointestinal series show a large stone surrounded by contrast agent in duodenal bulb, resulting in partial gastric outlet obstruction (arrow).

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

    Upper gastrointestinal series show a cholecystoduodenal fistula and partial filling of the gallbladder (open arrow). The filling defect in the gallbladder is caused by a gallstone (closed arrow).

     
    Area of Interest: Abdomen; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Fistula;
     
     
Contrast-enhanced axial CT image shows subtle gastric distention secondary to impaction of a gallstone in proximal duodenum. A stone is noted in the neck (open arrow), and in the body of the gallbladder (closed arrow).
 
Contrast-enhanced CT image obtained caudal to A shows pneumobilia in a partially contracted gallbladder. The gallbladder seems to communicate directly with adjacent duodenum and a large laminated gallstone is abutting the duodenal bulb (arrow).
 
Contrast-enhanced oblique reformatted CT image shows stone in the neck (small open arrow) and body (large open arrow) of the gallbladder. Adjacent a cholecystoduodenal fistula with stone migration into the duodenum is noted (closed arrow).
 
Upper gastrointestinal series show a large stone surrounded by contrast agent in duodenal bulb, resulting in partial gastric outlet obstruction (arrow).
 
Upper gastrointestinal series show a cholecystoduodenal fistula and partial filling of the gallbladder (open arrow). The filling defect in the gallbladder is caused by a gallstone (closed arrow).
 
 
 
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