DOI: 10.1148/rg.244035222
Bouveret Syndrome1
G. Brooks Brennan, MD,
Robert D. Rosenberg, MD and
Sanjeev Arora, MD
1 From the Departments of Radiology (G.B.B., R.D.R.) and Internal Medicine (S.A.), University of New Mexico, 2211 Lomas Blvd, Albuquerque, NM 87106. Received November 28, 2003; revision requested January 7, 2004, and received February 18; accepted March 10. Address correspondence to G.B.B. (e-mail: gbbrennan@salud.unm.edu).
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Figure 1. Cholelithiasis. Upright frontal radiograph shows multiple curvilinear areas of increased opacity in the right upper quadrant (arrow). The maximal diameter is approximately 3-4 cm. Incidental note is made of a paucity of bowel gas, even in the expected region of the stomach.
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Figure 2a. Bouveret syndrome. (a) Transverse sonogram obtained over the expected location of the gallbladder fossa shows a curvilinear focus of increased echogenicity with posterior shadowing, findings consistent with a large gallstone. (b) Transverse sonogram obtained over the epigastrium shows a dilated stomach (STO). (c) Longitudinal sonogram obtained over the liver shows multiple foci of increased echogenicity with ring-down artifact (arrows), findings suggestive of pneumobilia.
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Figure 2b. Bouveret syndrome. (a) Transverse sonogram obtained over the expected location of the gallbladder fossa shows a curvilinear focus of increased echogenicity with posterior shadowing, findings consistent with a large gallstone. (b) Transverse sonogram obtained over the epigastrium shows a dilated stomach (STO). (c) Longitudinal sonogram obtained over the liver shows multiple foci of increased echogenicity with ring-down artifact (arrows), findings suggestive of pneumobilia.
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Figure 2c. Bouveret syndrome. (a) Transverse sonogram obtained over the expected location of the gallbladder fossa shows a curvilinear focus of increased echogenicity with posterior shadowing, findings consistent with a large gallstone. (b) Transverse sonogram obtained over the epigastrium shows a dilated stomach (STO). (c) Longitudinal sonogram obtained over the liver shows multiple foci of increased echogenicity with ring-down artifact (arrows), findings suggestive of pneumobilia.
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Figure 3a. Bouveret syndrome. (a) CT scan of the upper abdomen, obtained with oral and intravenous contrast material at 8-mm collimation, shows two low-attenuation gallstones in the lumina of the duodenum and gallbladder. The stone in the gallbladder is surrounded by high-attenuation material, which possibly represents oral contrast material. (b) CT scan shows a curvilinear, air-filled fistula that extends from the gallbladder fossa toward the second part of the duodenum (arrow). (c) CT scan obtained superior to a and b shows pneumobilia and gastric distention (*).
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Figure 3b. Bouveret syndrome. (a) CT scan of the upper abdomen, obtained with oral and intravenous contrast material at 8-mm collimation, shows two low-attenuation gallstones in the lumina of the duodenum and gallbladder. The stone in the gallbladder is surrounded by high-attenuation material, which possibly represents oral contrast material. (b) CT scan shows a curvilinear, air-filled fistula that extends from the gallbladder fossa toward the second part of the duodenum (arrow). (c) CT scan obtained superior to a and b shows pneumobilia and gastric distention (*).
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Figure 3c. Bouveret syndrome. (a) CT scan of the upper abdomen, obtained with oral and intravenous contrast material at 8-mm collimation, shows two low-attenuation gallstones in the lumina of the duodenum and gallbladder. The stone in the gallbladder is surrounded by high-attenuation material, which possibly represents oral contrast material. (b) CT scan shows a curvilinear, air-filled fistula that extends from the gallbladder fossa toward the second part of the duodenum (arrow). (c) CT scan obtained superior to a and b shows pneumobilia and gastric distention (*).
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Figure 4a. Endoluminal images from ERCP. (a) A large, 4-cm-diameter gallstone is seen in the second part of the duodenum, with bile noted proximal to the stone. Multiple attempts to snare the stone were unsuccessful. (b) More proximal to the impacted stone, there is a large gallstone eroding through the lateral wall of the duodenum.
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Figure 4b. Endoluminal images from ERCP. (a) A large, 4-cm-diameter gallstone is seen in the second part of the duodenum, with bile noted proximal to the stone. Multiple attempts to snare the stone were unsuccessful. (b) More proximal to the impacted stone, there is a large gallstone eroding through the lateral wall of the duodenum.
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Figure 5. Gallstone ileus. Frontal abdominal radiograph obtained several days after ERCP shows two calcific areas of increased opacity (arrows). One is in the right upper quadrant (top arrow), the same location as on the earlier radiograph (Fig 1); the other is now in the terminal ileum (bottom arrow). Incidental note is made of a percutaneous cholecystostomy drainage catheter in the right upper abdomen.
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Copyright © 2004 by the Radiological Society of North America.
