Síndrome de Bouveret

espanolEl sindrome de Bouveret es una causa rara de ileo biliar proximal con obstruccion del duodeno o de la salida gastrica. Es causada por la impactacion de calculos biliares ectopicos de gran tamano en el duodeno proximal y es una complicacion de la colelitiasis cronica con fistula colecistogastrica o colecistoenterica. Debido a su rareza, y sintomatologia inespecifica, en el diagnostico diferencial apenas se le considera como etiologia de la obstruccion de la salida gastrica. Los sintomas clinicos son totalmente vagos. La sintomatologia de presentacion mas comun es dolor abdominal epigastrico o en cuadrante superior derecho difuso, nauseas, vomitos, hematemesis y perdida de peso. Sin un diagnostico oportuno, puede asociarse con altas tasas de morbilidad y mortalidad, por lo que es importante hacer un diagnostico y tratamiento temprano. Los hallazgos de la tomografia computada son neumobilia, fistula colecistoduodenal y un calculo biliar en el duodeno o triada de Rigler, la cual es patognomonica. El objetivo primordial de la terapia es aliviar la obstruccion mediante la eliminacion del calculo. El tratamiento ideal es endoscopico y si fracasa se debe realizar la cirugia. Presentamos un caso de sindrome de Bouveret. EnglishBouveret's syndrome is a rare cause of proximal biliary ileus with obstruction of the duodenum or gastric outlet. It is caused by impaction of large ectopic gallstones in the proximal duodenum and is a complication of chronic cholelithiasis with cholecystogastric or cholecystoenteric fistula. Due to its rarity, and non-specific symptomatology, in the differential diagnosis, it is hardly considered as the etiology of the obstruction of the gastric outlet. Clinical symptoms are totally vague. The most common symptomatology is epigastric abdominal pain or diffuse upper right quadrant, nausea, vomiting, hematemesis and weight loss. Without a timely diagnosis, it can be associated with high morbidity and mortality rates, so it is important to make an early diagnosis and treatment. Findings of the computed tomography are pneumobilia, cholecystoduodenal fistula and a gallstone in the duodenum or Rigler's triad, which is pathognomonic. The primary goal of therapy is to relieve the blockage by removing the gallstones. The ideal treatment is endoscopic and if it fails surgery should be performed. We present a case of Bouveret's syndrome.