English

Abstract

Bouveret's syndrome is defined as gastric outlet obstruction caused by duodenal impaction of a large gallstone which passes into the duodenal bulb through a cholecystogastric or cholecystoduodenal fistula. We describe a case of Bouveret's Syndrome in an middle aged patient that was successfully treated with resection of distal part of stomach and 1st part of duodenum by laparotomy. We will also review the literature on this uncommon condition. Biliary enteric fistula is as such a rare complication and comparatively rare cause of intestinal obstruction. And even if becomes so; generally it lodges in the terminal ileum and rarely in duodenum. Obstructing proximal part of duodenum or distal part of stomach is a curiosity and i.e. Bouveret's syndrome. Generally patient presents with nausea, vomiting, haematemesis, abdominal distention or epigastric pain. G.I. bleeding, obstructive jaundice, pancreatitis or duodenal or gastric perforation are rare complications. The treatment is purely surgical - either enterolithotomy or gastrotomy with associated cholecystectomy with repair of fistula or enterolithotomy with or without second stage cholecystectomy. It is worth to mention here that so far histological findings of Bouveret's syndrome are not described in the literature. Even though findings are not that much specific; but presence of foci of abscesses, dense mixed inflammatory exudates in all the coats of distal part of stomach, 1st part of duodenum and gall bladder along with formation of lymphoid follicles with prominent germinal centers in muscle coat are definitely mentionable and we feel these may give clue. On gross examination the thickness of stomach wall and duodenal wall are increased and there is narrowing of lumen. If there is stone in gall bladder; it may also show thickened out wall due to presence of chronic cholelithiasis with cholecystitis.