Bouveret Syndrome: Large Gallstone Causing Duodenal Obstruction

Abstract

Introduction: Bouveret syndrome consists of a gastric outlet obstruction due to the impaction of a gallstone in the duodenal bulb after it migrates through a cholecystoduodenal fistula. This syndrome represents only 1% to 3% of all cases of gallstone ileus, being more frequent in women and in the elderly. Case report: 86-year-old patient with diffuse colicky abdominal pain, diarrhea, and yellowish vomiting. The imaging tests revealed significant duodenal dilation with the presence of a cholecystoduodenal fistula and a large rounded impacted gallstone. The patient underwent emergency surgery through an enterotomy with removal of the gallstone and primary closure. Discussion: Bouveret's syndrome is a rare gallstone ileus condition that implies significant morbidity and mortality and often occurs in the elderly with significant comorbidities. Individual diagnosis and treatment strategies are required for optimal management and results, being endoscopic treatment or open surgery the two most suitable available options. Conclusions: Bouveret syndrome is a life-threatening condition with gastric outlet obstruction caused by large gallstones. CT and MRI scans are useful for diagnosis. Although in some cases percutaneous and endoscopic treatments can be successful as first-line treatment, most patients require surgery, however, the decision must be taken individually.