病例报告：巨大的胆结石导致胆囊十二指肠瘘伴Bouveret综合征和急性胰腺炎
Case Report: A giant gallstone causing cholecystoduodenal fistula with Bouveret syndrome and acute pancreatitis.
摘要(中文译文)
Bouveret综合征是一种罕见的胆石性肠梗阻，其特征为胆结石经胆囊十二指肠瘘迁移至胃肠道后嵌顿，导致胃出口梗阻。该病主要发生于合并多种基础疾病的老年患者。涉及巨大胆结石并并发急性胰腺炎的病例极为罕见，且治疗极具挑战性。患者为72岁女性，因持续右上腹疼痛及腹胀6天入院，伴恶心、呕吐和便秘。其既往病史包括糖尿病、高血压、既往脑梗死及慢性肾功能不全。体格检查发现右上腹明显压痛，Murphy征阳性。实验室检查显示白细胞增多及血清淀粉酶显著升高，符合急性胰腺炎表现。腹部计算机断层扫描（CT）显示胆石症、胆囊炎、胆道积气，以及提示胆囊十二指肠瘘的征象。内镜检查发现一枚约3.5×6.0 cm的巨大胆结石嵌顿于十二指肠降部，导致完全性梗阻。在全身麻醉下，于C臂透视引导下，采用液电碎石术联合取石篮及圈套器，通过单次内镜操作成功将结石碎裂并取出。手术在单次全身麻醉下完成，恢复了十二指肠通畅。术后患者接受广谱静脉抗生素及支持治疗，症状显著缓解。患者恢复顺利，于术后第6天出院，三个月随访期间未见复发。本病例提示，对于老年高危患者，内镜下碎石及取石术可作为巨大胆结石所致Bouveret综合征的安全、有效且微创的一线治疗选择，尤其在并发急性胰腺炎时，具有重要的临床参考价值。
Abstract
Bouveret syndrome is a rare form of gallstone ileus characterized by gastric outlet obstruction secondary to impaction of a gallstone that has migrated into the gastrointestinal tract through a cholecystoduodenal fistula. It predominantly occurs in elderly patients with multiple comorbidities. Cases involving giant gallstones complicated by acute pancreatitis are exceedingly uncommon and pose significant therapeutic challenges. A 72-year-old woman was admitted with a 6-day history of persistent right upper quadrant abdominal pain and distension, accompanied by nausea, vomiting, and constipation. Her medical history was notable for diabetes mellitus, hypertension, prior cerebral infarction, and chronic renal insufficiency. Physical examination revealed marked tenderness in the right upper quadrant with a positive Murphy's sign. Laboratory evaluation demonstrated leukocytosis and markedly elevated serum amylase levels, consistent with acute pancreatitis. Abdominal computed tomography (CT) showed cholelithiasis, cholecystitis, pneumobilia, and findings suggestive of a cholecystoduodenal fistula. Endoscopy revealed a giant gallstone measuring approximately 3.5 × 6.0 cm impacted in the descending portion of the duodenum, resulting in complete obstruction. Under general anesthesia, the stone was successfully fragmented and removed in a single endoscopy session using electrohydraulic lithotripsy combined with a retrieval basket and snare under C-arm fluoroscopic guidance. The procedure was completed under a single session of general anesthesia, restoring duodenal patency. Postoperatively, the patient received broad-spectrum intravenous antibiotics and supportive therapy, with significant symptom relief. She recovered uneventfully and was discharged on postoperative day 6, with no recurrence observed during three-month follow-up. This case highlights that, in elderly high-risk patients, endoscopic lithotripsy and stone extraction may serve as a safe, effective, and minimally invasive first-line treatment option for Bouveret syndrome caused by giant gallstones, particularly when complicated by acute pancreatitis, offering valuable clinical insight.
如何引用
AMA
Xiong Fan, Qianxiong Huang. Case Report: A giant gallstone causing cholecystoduodenal fistula with Bouveret syndrome and acute pancreatitis.. Frontiers in medicine. 2026; doi:10.3389/fmed.2026.1813702.
APA
Xiong Fan, Qianxiong Huang (2026). Case Report: A giant gallstone causing cholecystoduodenal fistula with Bouveret syndrome and acute pancreatitis.. Frontiers in medicine. https://doi.org/10.3389/fmed.2026.1813702
GB/T 7714
Xiong Fan, Qianxiong Huang. Case Report: A giant gallstone causing cholecystoduodenal fistula with Bouveret syndrome and acute pancreatitis.[J]. Frontiers in medicine, 2026 doi:10.3389/fmed.2026.1813702.
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