BACKGROUND Bouveret syndrome is a rare complication of cholelithiasis,with only 315 cases reported in the literature between 1967 and 2016.Delay in diagnosis is associated with a high mortality rate.Diagnosis is based...BACKGROUND Bouveret syndrome is a rare complication of cholelithiasis,with only 315 cases reported in the literature between 1967 and 2016.Delay in diagnosis is associated with a high mortality rate.Diagnosis is based upon clinical manifestations,gastroscopy,and imaging studies such as abdominal computed tomography and magnetic resonance cholan-giopancreatography.Endoscopic stone extraction or lithotripsy is the preferred choice for treatment as it is safe and minimally invasive with few complications.However,if endoscopy fails,surgery is required.CASE SUMMARY A 61-year-old female patient presented with recurrent epigastric pain for more than 6 mo.On endoscopy,a large amount of food residue was present in the stomach with multiple stones and ulcers in the antro-pyloric region.Based on these findings,a diagnosis of gastrolithiasis was made.However,computed tomography of the abdomen revealed the correct diagnosis of Bouveret syndrome.Initially,endoscopic treatment was attempted but it failed.Later,she was successfully managed by cholecystectomy with duodenal stone extraction and fistula repair(one-step method).At the last follow-up 6 mo after surgery,the patient was symptom-free.CONCLUSION Bouveret syndrome is a rare complication of gallstones that requires prompt endoscopic or surgical treatment to prevent mortality.展开更多
BACKGROUND Appendectomy is the procedure of choice for the treatment of acute appendicitis.However,surgery may not be appropriate for patients with coexisting severe illness or comorbidities such as acute pancreatitis...BACKGROUND Appendectomy is the procedure of choice for the treatment of acute appendicitis.However,surgery may not be appropriate for patients with coexisting severe illness or comorbidities such as acute pancreatitis(AP).Endoscopic retrograde appendicitis treatment(ERAT)may be a novel alternative to surgery for treating such patients where existing medical therapies have failed.CASE SUMMARY We report 2 cases of moderately severe AP who developed acute uncomplicated appendicitis during their hospital stay and did not respond to traditional medical therapy.One patient had moderately severe AP due to hyperlipidemia,while the other patient had a gallstone induced by moderately severe AP.Neither patient was fit to undergo an appendectomy procedure because of the concurrent AP.Therefore,the alternative and minimally invasive ERAT was considered.After written informed consent was collected from the patients,the ERAT procedure was performed.Both patients exhibited fast postoperative recovery after ERAT with minimal surgical trauma.CONCLUSION ERAT is a safe and effective minimally invasive endoscopic procedure for acute appendicitis in patients with coexistent AP.展开更多
文摘BACKGROUND Bouveret syndrome is a rare complication of cholelithiasis,with only 315 cases reported in the literature between 1967 and 2016.Delay in diagnosis is associated with a high mortality rate.Diagnosis is based upon clinical manifestations,gastroscopy,and imaging studies such as abdominal computed tomography and magnetic resonance cholan-giopancreatography.Endoscopic stone extraction or lithotripsy is the preferred choice for treatment as it is safe and minimally invasive with few complications.However,if endoscopy fails,surgery is required.CASE SUMMARY A 61-year-old female patient presented with recurrent epigastric pain for more than 6 mo.On endoscopy,a large amount of food residue was present in the stomach with multiple stones and ulcers in the antro-pyloric region.Based on these findings,a diagnosis of gastrolithiasis was made.However,computed tomography of the abdomen revealed the correct diagnosis of Bouveret syndrome.Initially,endoscopic treatment was attempted but it failed.Later,she was successfully managed by cholecystectomy with duodenal stone extraction and fistula repair(one-step method).At the last follow-up 6 mo after surgery,the patient was symptom-free.CONCLUSION Bouveret syndrome is a rare complication of gallstones that requires prompt endoscopic or surgical treatment to prevent mortality.
文摘BACKGROUND Appendectomy is the procedure of choice for the treatment of acute appendicitis.However,surgery may not be appropriate for patients with coexisting severe illness or comorbidities such as acute pancreatitis(AP).Endoscopic retrograde appendicitis treatment(ERAT)may be a novel alternative to surgery for treating such patients where existing medical therapies have failed.CASE SUMMARY We report 2 cases of moderately severe AP who developed acute uncomplicated appendicitis during their hospital stay and did not respond to traditional medical therapy.One patient had moderately severe AP due to hyperlipidemia,while the other patient had a gallstone induced by moderately severe AP.Neither patient was fit to undergo an appendectomy procedure because of the concurrent AP.Therefore,the alternative and minimally invasive ERAT was considered.After written informed consent was collected from the patients,the ERAT procedure was performed.Both patients exhibited fast postoperative recovery after ERAT with minimal surgical trauma.CONCLUSION ERAT is a safe and effective minimally invasive endoscopic procedure for acute appendicitis in patients with coexistent AP.
