Author/Editor		Golobinek, Rajko
Title		Visoki ileus, povzročen z žolčnim kamnom (Bouveretov sindrom) - prikaz primera
Translated title		High gallstone ileus (Bouveret's syndrome) - a case report
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 75, št. 12
Publication year		2006
Volume		str. 843-6
Language		slo
Abstract		Background Mechanical ileus caused by gallstones (Bouveret syndrome) is late complication of cholelithiasis. Chronical irritation and recurrent conservativelly treated episodes of acute cholecystitis lead to weakening of gallblader wall and formation of internal biliar fistula (predominantly into duodenum). Gallstones migration through the fistula cams cause intestinal obstruction, which requires surgical treatment. Patients and methods A case of a 78-years old female patient with high ileus is presented. Preoperative examinations (endoscopy, gastroduodenography, abdominal ultrasound, CT scan and histology) suggested duodenal obstruction due to translocated and impacted gallstone - Bouveret syndrome. Intraoperativelly this diagnosis was confirmed, gallstone removed and cholecystectomy and the cholecystoduodenal fistula repair was made. Conclusions The Bouverets yndrome is a rare cause of mechanical ileus. It is presented in aged patients as late complication of gallstones and demands operative treatment. Desobstruction is mandatory, according to patient's general condition cholecystectomy and fistula repair are strongly recomended.
Summary		Izhodišča Mehanični ileus, povzročen z žolčnimi kamni (Bouveretov sindrom), je kasen zaplet holelitiaze. Kronično draženje in konzervativno zdravljenje akutnih zagonov holecistitisa privedeta ob dekubitusu stene postopno do razvoja notranje biliarne fistule v prebavni trakt (najpogosteje v dvanajstniku). Prehajanje žolčnih kamnov skozi fistulo v črevo lahko povzroči obstrukcijo, ki zahteva operativno zdravljenje. Bolniki in metode Prikazan je primer 78-letne bolnice z visokim ileusom, pri kateri so predoperativne preiskave (endoskopija, gastroduodenografija, ultrazvok, CT in histologija) govorile za obstrukcijo v dvanajstniku zaradi preseljenega in vkleščenega žolčnega kamna - Bouveretov sindrom. Medoperativno smo diagnozo potrdili, odstranili kamen, napravili holecistektomijo ter sanirali tudi holecistoduodenalno fistulo. Zaključki Bouveretov sindrom je redek vzrok za mehanični ileus. Pojavlja se v visoki starosti kot pozni zaplet žolčnih kamnov in praviloma zahteva operativno zdravljenje. Po razrešitvi obstrukcije je ob ugodnem splošnem stanju bolnika potrebno napraviti še holecistektomijo in odstraniti fistulo.
Descriptors		INTESTINAL OBSTRUCTION CHOLELITHIASIS CHOLECYSTECTOMY AGED