RESUMEN
Bouveret´s syndrome refers to the condition of gastric outlet obstruction caused by the impaction of a large gallstone into the duodenum after passage through a cholecystoduodenal fistula. Many endoscopic and surgical techniques have been described in the management of this syndrome, however the morbidity and mortality are still very high. We present the case of a 67-year-old female patient with Bouveret´s syndrome, with successful resolution with surgical treatment after two failed endoscopic treatments.
El síndrome de Bouveret se refiere a la obstrucción de la salida gástrica causada por un lito grande impactado en el duodeno que pasó a través de una fístula colecistoduodenal. Se han descrito varias técnicas endoscópicas y quirúrgicas para tratar esta entidad, pero la morbimortalidad es aún muy elevada. Se presenta el caso de una paciente femenina de 67 años con síndrome de Bouveret, con exitosa resolución mediante tratamiento quirúrgico posterior a dos tratamientos endoscópicos fallidos.
Asunto(s)
Obstrucción Duodenal/complicaciones , Cálculos Biliares/complicaciones , Obstrucción de la Salida Gástrica/etiología , Enfermedades Raras/etiología , Anciano , Fístula Biliar/complicaciones , Obstrucción Duodenal/cirugía , Femenino , Cálculos Biliares/cirugía , Obstrucción de la Salida Gástrica/cirugía , Humanos , Fístula Intestinal/complicaciones , Enfermedades Raras/cirugía , SíndromeRESUMEN
BACKGROUND: A short right renal vein (RRV) remains a challenge for renal transplant surgery, especially in the living donor. Different techniques exist to obtain an RRV with a suitable length in cadaveric donor; however, in living donors the options are limited. MATERIAL AND METHODS: We present 2 living kidney transplants in which we obtained a very short RRV, making the implantation very difficult. We describe our technique to overcome this problem by using cadaveric iliac vessels retrieved from previous cadaveric donations and preserved at 4°C in histidine-tryptophan-ketoglutarate (HTK) solution, without intraoperative or postoperative complications. We complied with the Helsinki Congress and the Istanbul Declaration regarding the donor source. RESULTS: In both cases, kidney grafts had optimal primary function, with good creatinine clearance after transplant and good patency of vascular anastomosis by Doppler ultrasounds. CONCLUSIONS: We believe the use of cadaveric vessel grafts in living donor kidney transplant is a valuable resource as a rescue tool in emergency situations like the ones being presented in this article in order to avoid discarding a kidney graft with damage or short vessels. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.