Abstract
Absence of Leukocytosis in Gallstone Ileus (Bouveret Syndrome)
Vernon A. Chuabio1, Eric B. Yasay1
1Division of Gastroenterology, Department of Medicine, University of the Philippines-Philippine General Hospital
Background: Gallstone ileus is an uncommon complication of cholelithiasis, with an incidence of <0.5% among patients presenting with mechanical small bowel obstruction. In addition to a clinical presentation of upper gut obstruction, leukocytosis may be seen, presumably due to inflammation as part of the pathophysiology.
Clinical Presentation: A 65-year-old hypertensive female presented with one-week severe non-radiating epigastric pain and post-prandial vomiting. Prior less severe intermittent epigastric bloating pains were already noted. She was received at the hospital with improved abdominal pain with soft nondistended abdomen, but positive for succussion splash.
Management: Subsequent exploratory laparotomy was done, confirming a cholecystoduodenal fistula with the gallstone already noted 11 feet from the ileocecal valve and 4 feet from the ligament of Treitz, causing upstream jejunal dilatation. Enterolithotomy and enterorrhaphy were then performed. The patient was discharged well after an unremarkable postoperative course.
Recommendation: Gallstone ileus, though uncommon, should still be considered among elderly female patients with acute onset of symptoms of upper gut obstruction even in the absence of leukocytosis.
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
| Monthly Critical Appraisal of Topics Conferences to be gaciliated by Research Coordinators per Institution | Monthly Critical Appraisal of Topics Conferences per Institution |
| CAT Plenary/Liver Con Dates: September 23, 2023 December 16, 2023 March 2024 (During the JAC) Resumption of face-to-face Quarterly Critical Appraisal of Topics facilitated by the JRRE |
2 Clinical scenarios and articles are to be sent to institutions each on August 2023, November 2023, and February 2024; |
| Hybrid Research Workshop 4 week asynchronous via Moodle, followed by a 1 day on-site Onsite Workshop Research Protocol Presentation for Level I GI Fellows-In-Training - Research Protocol Presentation: August 12, 2023 - Research Forums of the Tripartite Societies |
Week 1: July 15-21, 2023 Week 2: July 22-28, 2023 Week 3: July 29-August 4, 2023 Week 4: August 5-11, 2023 |
| Research Manuscript Workshop for level II GI Fellows-In-Training | January 6, 2024 |