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Review
. 2014 Nov-Dec;99(6):819-23.
doi: 10.9738/INTSURG-D-14-00087.1.

Bouveret's Syndrome: An Overlooked Diagnosis. A Case Report and Review of Literature

Ghazi Raji Qasaimeh  1 , Sohail Bakkar, Khaled Jadallah
Affiliations
Review

Bouveret's Syndrome: An Overlooked Diagnosis. A Case Report and Review of Literature

Ghazi Raji Qasaimeh et al. Int Surg. 2014 Nov-Dec.

Abstract

Bouveret's syndrome is a rare cause of gastric outlet obstruction. Its diagnosis is often delayed or overlooked. It is characterized by the passage of a large gall bladder stone through a bilio-duodenal fistula, which becomes lodged in the duodenum causing duodenal obstruction. We report the case of a 70-year-old male with a history suggestive of gall bladder disease over a 1-year period. The diagnosis was confirmed by ultrasound, which showed a single large gall bladder stone and the patient was planned for elective laparoscopic cholecystectomy. One week prior to the elective surgery he presented with upper gastrointestinal bleeding for which he was admitted, diagnosed by a gastroenterologist as bleeding duodenal ulcer and treated by local epinephrine injection and blood transfusion. One week later he presented with a picture of acute gastric outlet obstruction, which proved by endoscopy to be due to a large stone impacted in the duodenum. Endoscopic management failed and the stone was managed by open surgery. The patient made a good postoperative recovery and for the last year he has remained free of symptoms.

Keywords: Bouveret's syndrome; Gallstone ileus; Gastric outlet obstruction.

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Figures

Fig. 1
Fig. 1
Ectopic gallstone (thick arrow), pneumobilia (thin arrow) and shadow of dilated stomach (curved arrow).
Fig. 2
Fig. 2
Stone in the opened duodenum (arrow head) and gallbladder (arrow).
Fig. 3
Fig. 3
The extracted ectopic gallstone (5 × 3.5 cm).
Fig. 4
Fig. 4
The extracted stone (arrow). Index finger in the duodenum and the tip of suction pointing to the fistula between the duodenum and gall bladder.
See this image and copyright information in PMC

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