Centro Universitario de Ciudad Juárez

Introduction: Bouveret syndrome, a rare cause of gastrointestinal outlet obstruction, was first described by Beassier in 1770. Afterward, this condition was named after Leon Bouveret in 1896. Bouveret syndrome is characterized by the passage of a gallstone through a cholecystogastric or more commonly through a cholecystoduodenal fistula, causing obstruction. Case Report: A 70-year-old male patient without chronic degenerative diseases and with history of epigastric pain months prior to his current evaluation. Five days before hospital admission, the patient experienced worsening of the epigastric pain with an intensity of 8/10 accompanied by anorexia, vomiting, jaundice, and choluria. Physical examination with evidence of generalized jaundice ++, painful and distended abdomen in the upper right quadrant. Diagnostic protocol was initiated based on preoperative tests, which showed hyperbilirubinemia of 2.78 mg/dL with an obstructive pattern and alteration of liver function tests. The hepatobiliary ultrasound showed a lithiasic sclero-atrophic gallbladder, a common bile duct diameter of 5 mm and positive sonographic murphy sign. The patient was taken to the operating room where, after general anesthesia and in a supine position, a 13 mmHg pneumoperitoneum was created and laparoscopic working ports were introduced. A laparoscopic cholecystectomy + trancystic cholangiography + resection of the cholecystoduodenal fistula were performed. Conclusion: A high degree of clinical suspicion and imaging studies are required to establish Bouveret syndrome diagnosis, nevertheless in 50% of cases, the diagnosis is made intraoperatively. Early diagnosis and adequate surgical intervention are essential for a favorable prognosis.

Resumen. El artículo esboza los antecedentes del desarrollo local que se fueron materializando en la búsqueda de un modelo económico, social y político que comienza a gestarse con el triunfo de la Revolución Cubana. Se presentan las particularidades de los gobiernos locales en nuestro contexto y cómo a diferencia de la ocurrencia de procesos reales de descentralización a nivel regional, nuestro país fue orientándose cada vez más hacia un modelo excesivamente centralizado. Al mismo tiempo se contextualiza el surgimiento del tema del desarrollo local en los noventa y las iniciativas generadas a raíz de los cambios ocurridos en el período señalado. Se ofrecen también las contradicciones y rasgos más esenciales que marcan el debate por el desarrollo y los gobiernos locales en el contexto actual. Se valoran las posibilidades que existen, desde los territorios y en especial en los gobiernos locales para propiciar procesos de desarrollo local. Palabras clave: Cuba, gobierno local, crisis de la sociedad cubana, descentralización. Abstract. The article outlines the antecedents of local development that were materialized in the search for an economic, social, and political model that begins to take shape with the triumph of the Cuban Revolution. The particularities of local governments are presented in our context and how, unlike the occurrence of real decentralization processes at the regional level, our country was increasingly oriented towards an excessively centralized model. At the same time, the emergence of the issue of local development in the 1990s and the initiatives generated because of the changes that took place during the indicated period are contextualized. The most essential contradictions and features that mark the debate over development and local governments in the current context are also offered. The possibilities that exist, from the territories and especially in local governments to promote local development processes, are valued. Key words: Cuba, local government, crisis of cuban society, decentralization.