Fact-sheet: Ballstone ileus and Bouveret's syndrome
Updated on 01/14/2023 at 8:50 PM
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Definition
High intestinal obstruction due to impaction of a large gallstone that has perforated the gallbladder wall, thereby creating a biliary-enteric fistula.
This situation results from progressive erosion of the gallbladder wall by this stone, which is too large to migrate through the biliary system.
Clinical features
Obstructive syndrome:
if the fistula is duodenal and the stone impacts in the lumen of the duodenal loop, the obstruction will be high, gastric (Bouveret syndrome); if the stone impacts further, most often in the small bowel, it causes a small bowel obstruction that is clinically distinguished by a progressive clinical presentation, unlike a classic small bowel obstruction due to adhesions, for example.
Ultrasound
Pneumobilia.
Collapsed gallbladder with gas in the gallbladder fossa.
Gastric stasis without small bowel dilation: Bouveret syndrome.
Small bowel distension (semiology of mechanical small bowel obstruction) if the stone is impacted in the small bowel.
Ascites
CT
Key finding: search for Rigler's triad: -Pneumobilia. -Small bowel obstruction. -Identification of an ectopic gallstone. Search for a biliary-enteric fistula