Gall bladder distension causing gastric outlet obstruction: a variant of Bouveret's syndrome

Abstract

Distal small bowel obstruction secondary to gallstone ileus is a rare but well-known presentation of cholecystoenteric fistula. Bouveret's syndrome is due to the proximal impaction of gallstone in the duodenum or pylorus resulting in the obstruction of the gastric outlet. The diagnosis of this condition can be made by investigations such as oral contrast studies and upper endoscopy. Diagnosis should be made and treatment instituted promptly to avoid complications resulting from rapid dehydration and electrolyte imbalance. Treatment aims to relieve the gastric outlet obstruction, to close the cholecystoduodenal fistula and to prevent further gallbladder complications. Management plan depends on the age, general condition, and operative findings of the individual patient. This paper presents a patient with a variant of Bouveret's syndrome. In this case report, upper gastrointestinal obstruction was not due to the direct impaction of gallstone at the gastric outlet. The diagnosis was made by computer tomography scan which showed distended gall bladder compressing on the duodenum resulting in gastric outlet obstruction. This patient was managed non-surgically with ultrasound-guided decompression of the gall bladder leading to the clinical resolution of the Bouveret's syndrome.