Ulus Travma Acil Cerrahi Derg. 2013; 19(4): 375-379 | DOI: 10.5505/tjtes.2013.97254

Bouveret sendromu: Çok kesitli bilgisayarlý tomografi ve kontrastlý manyetik rezonans kolanjiyografi bulgularý

Oktay Algýn¹, Evrim Özmen¹, Melike Ruþen Metin¹, Pamir Eren Ersoy², Mustafa Karaoðlanoðlu^1
1Atatürk Eðitim Ve Araþtýrma Hastanesi, Radyoloji Kliniði, Ankara
²Atatürk Eðitim Ve Araþtýrma Hastanesi, Genel Cerrahi Kiliniði, Ankara

Kolesistoenterik fistüller, safra taþlarýnýn %1’den daha az bir sýklýkta görünen komplikasyonlarýndandýr. Bouveret sendromu, mide çýkýmýnda safra taþý/taþlarý tarafýndan oluþturulan týkanýklýk sonucu geliþir. Bu taþlar sýklýkla kolesistoenterik veya nadiren de kolesistogastrik fistül aracýlýðý ile mide çýkýmýný veya proksimal duedenumu týkarlar. Bouveret sendromunun erken taný ve tedavisi, morbidite ve mortalitenin azaltýlmasý için gereklidir. Bu olgu sunumunda, kolesistoenterik fistüllü ve Bouveret sendromlu bir hasta sunuldu. Bildiðimiz kadarýyla, çokkesitli bilgisayarlý tomografi (ÇKBT) (64 dedektörlü) ve kontrastlý manyetik rezonans (MR) kolanjiyopankreatografi (MRKP) ile Bouveret sendromu tanýsý hakkýnda çalýþma literatürde bulunmamaktadýr. Amacýmýz kolesistoenterik fistüllerin saptanmasý ve deðerlendirilmesinde ÇKBT ve kontrastlý MRKP etkinliðini tartýþmaktýr. ÇKBT ve kontrastlý MRKP ile safra yollarýný fizyolojik olarak inceleyebildik ve biliyoenterik fistülü net olarak gösterdik. Ayrýca kontrastlý MRKP ile fizyolojik olarak safra sistemini deðerlendirdik. Sonuç olarak, bu tür olgularda ÇKBT, röntgen ve ultrasondan sonraki ilk tercih olmalýdýr. Komplike veya safra týkanýklýðý þüphesi olan olgularda kontrastlý MRKP, tüm karýn ve safra sistemi ile ilgili önemli morfolojik ve fizyolojik bilgileri verebilir.

Anahtar Kelimeler: Safra yollarý, Bouveret sendromu; fistül; mide çýkým obstrüksiyonu; safra kesesi; manyetik rezonans kolonanjiyografi; çok kesitli bilgisayarlý tomografi; safra taþý.

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Bouveret syndrome: evaluation with multidetector computed tomography and contrast-enhanced magnetic resonance cholangiopancreatography

Oktay Algýn¹, Evrim Özmen¹, Melike Ruþen Metin¹, Pamir Eren Ersoy², Mustafa Karaoðlanoðlu^1
1Department Of Radiology, Ataturk Training And Research Hospital, Ankara, Turkey
²Department Of General Surgery, Ataturk Training And Research Hospital, Ankara, Turkey

Cholecystenteric fistula is one of the rarest complications of biliary lithiasis, with a frequency of less than 1%. Bouveret syndrome is a gastric outlet obstruction produced by gallstone(s) located in the distal stomach or proximal duodenum. The route of gallstone migration to the bowel is most commonly via a cholecystoduodenal fistula; however, fistulization of the stomach is a rarer variation. Early diagnosis of this situation is crucial to reduce morbidity and mortality. In this report, we present a patient with cholecystogastric fistula and Bouveret syndrome. To our knowledge, there is no published paper in the literature related to the diagnosis of Bouveret syndrome with multidetector computed tomography (MDCT) (64 detectors) and/or contrast-enhanced magnetic resonance cholangiopancreatography (CE-MRCP). Our aim was to discuss the efficacy of MDCT and CE-MRCP in the detection and evaluation of cholecystenteric fistulas. We showed the exact localization and relation of biliary stones and the fistula by MDCT and CE-MRCP. We also evaluated the biliary system with CE-MRCP physiologically. In conclusion, when biliary lithiasis and ileus are detected in plain radiography, the firstline diagnostic tool should be MDCT. In complicated cases or when biliary obstruction is suspected, CE-MRCP can give important morphological and physiological information regarding the whole abdomen and biliary system.

Keywords: Bile ducts, Bouveret syndrome; fistula; gastric outlet obstruction; gallbladder; magnetic resonance cholangiography; multidetector row computed tomography; stone.

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