Bouveret’s syndrome: An unusual cause of gastric outlet obstruction

Abstract

Introduction: Bouveret’s syndrome is a rare cause of pylorus or duodenal obstruction. This syndrome represents only 1–3% of all cases of gallstone ileus, more frequent in women and in the elderly. The clinical presentation is quite nonspecific, but in most cases the symptomatology suggests an upper digestive obstruction. Case Report: We report a case of a 46-year-old man admitted with upper digestive obstruction due to a large biliary calculus that eroded through the gallbladder’s wall and pylorus, leading to digestive obstruction at this level. After attempted and unsuccessful endoscopic therapy, the patient was treated by surgery, with gastrotomy and gallstone removal. The fistula between the gallbladder and pylorus was not approached, because of the extent of the local inflammatory process, and elevated risk of complications. Conclusion: Despite of being a benign disease, the morbidity and mortality of this syndrome may be elevated. The main objective of the treatment is to resolve the digestive obstruction, which can be achieved by upper gastrointestinal (GI) endoscopy, but most patients require a surgical approach. The treatment of the cholecystoduodenal/cholecystopyloric fistula—one-or two-stage treatment—is controversial, depending on the local inflammation, fibrosis, and anatomic distortion, as well the clinical condition of the patient.