Surgical Treatment of a Female Patient with Bouveret’s Syndrome

INTRODUCTION: Gallstone disease (GSD) is a common and socially significant problem of modern society. Despite the fact that the disease has been sufficiently studied, there are still many controversial issues in diagnostics and choosing the correct treatment tactics. One of the rare complications of gallstone disease is Bouveret's Syndrome. The article presents a clinical case of surgical treatment of a 59-year-old patient with this syndrome. Early diagnostics of this complication was difficult for a number of reasons such as: the inability to perform computed tomography (CT) in the first days of the disease; difficulty in examining the duodenal bulb due to its deformation, as well as the patient's restless behavior and abundant vomiting during video gastroduodenoscopy (VGDS); simultaneous development of two complications: acute pancreatitis and intestinal obstruction. The surgery of choice in this case was enterotomy with gallstone extraction to eliminate high-level intestinal obstruction. During a follow-up ultrasound examination performed at an outpatient clinic, a concrement was found in the neck of the gallbladder. Due to the possible recurrence of the calculus migration into the small intestine and subsequent development of obstruction, after diagnostic video laparoscopy, it was decided to perform lithoextraction. CONCLUSION: Gallstone intestinal obstruction is a rare complication of cholecystolithiasis. The difficulty in diagnosing Bouveret's Syndrome is due to the atypical clinical picture, laboratory and instrumental data, which often leads to late surgical intervention. Cholecystolithiasis can be complicated by the migration of the calculus into the common bile duct and giving rise acute pancreatitis or acute cholecystitis. On the other hand, it can lead to development of a fistula and the occurrence of intestinal obstruction. CT-scanning is recommended and obviously advisable as the main diagnostic method, which allows for an early diagnosis of the disease and timely surgical treatment, which can be performed both open and either laparoscopically.