Upper gastrointestinal bleeding revealing a Bouveret syndrome: A case report

Abstract

Bouveret's syndrome is an uncommon cause of gastrointestinal obstruction. It's a result of the passage of a gallstone through a fistula connecting the gallbladder with the duodenum or stomach. The diagnosis is challenging due to its atypical clinical manifestations. There have been a few reported cases of Bouveret syndrome presenting with gastrointestinal bleeding. Treatment options include both endoscopic and surgical approaches. We present the case of a 92-year-old woman admitted to the emergency department for upper gastrointestinal bleeding. Gastroscopy revealed gastric stasis upstream of a calculus inducing an obstruction of the bulb. The computed tomography (CT) scan showed a cholecystoduodenal fistula with a calculus lodged in the bulb. The patient underwent a gastrostomy with extraction of the calculus. Postoperative course was uneventful and the patient was discharged home. In the majority of cases, Bouveret's syndrome is revealed by an upper gastrointestinal obstruction, but other signs, such as gastrointestinal bleeding, can be seen. The diagnosis is confirmed by an imaging method that highlights Rigler's triad. The management can be either endoscopic or surgical depending on the patient's general condition. The diagnosis is often difficult due to the lack of specificity in the symptoms. Presently, there exists no consensus concerning the appropriate approach for its management.