Abstract
We present a case report of a patient with Bouveret syndrome with interesting radiological findings and successful surgical treatment after failure of the endoscopic techniques. The report is followed by a review of the literature regarding the diagnostic means and proper treatment of this rare entity. Bouveret 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. This is a case of a 78-year-old patient with severe medical history who presented in bad general condition with an 8-day history of nausea, multiple bilious vomiting episodes, anorexia, discomfort in the right hypochondrium and epigastrium, and fever up to 38,5°C. The diagnosis of Bouveret syndrome was set after performing the proper imaging studies. An initial endoscopic effort to resolve the obstruction was performed without success. Surgical treatment managed to extract the impacted gallstone through an enterotomy after removal into the first part of the jejunum.
Highlights
Bouveret syndrome is a very uncommon form of gallstone ileus caused by the passage and impaction of a large gallstone through a cholecystoduodenal fistula into the duodenum, resulting in gastric outlet obstruction
The formation of a fistula is favoured by the long history of cholelithiasis, the repeated episodes of acute cholecystitis, the large size of the calculi (2–8 cm), the female gender and the advanced age of the patients [4]
The passage of a large gallstone through the fistula may lead to different manifestations depending on its size, the part of the alimentary tract involved in the fistula and the pre-existence of stenotic areas at this level [4]
Summary
Bouveret Syndrome—The Rarest Variant of Gallstone Ileus: A Case Report and Literature Review. We present a case report of a patient with Bouveret syndrome with interesting radiological findings and successful surgical treatment after failure of the endoscopic techniques. Bouveret 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. This is a case of a 78-year-old patient with severe medical history who presented in bad general condition with an 8-day history of nausea, multiple bilious vomiting episodes, anorexia, discomfort in the right hypochondrium and epigastrium, and fever up to 38,5∘C. Surgical treatment managed to extract the impacted gallstone through an enterotomy after removal into the first part of the jejunum
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