Surgical Duodenotomy Following Untreated Bouveret Syndrome

Abstract

Bouveret syndrome is caused by the impaction of a gallstone into the duodenum through a cholecystoduodenal fistula. This is typically followed by pyloric obstruction via retrograde migration of the stone, as opposed to anterograde migration, which can result in gallstone ileus. Bouveret syndrome usually presents with nausea, vomiting, and abdominal pain. Pneumobilia is seen on radiographic imaging. Herein, we describe a case of Bouveret syndrome where the diagnosis and treatment were delayed due to the initial patient desire for surgical intervention. Ultimately, duodenotomy was performed after several failed attempts of endoscopic stone extraction.

Keywords: bouveret syndrome; duodenotomy.

Figure 1. Initial CT scan illustrating the gallstone within the gallbladder (white arrow)

Figure 2. Computed tomography scan obtained one year after initial presentation showing extensive duodenal inflammation (white arrow).

Figure 3. Follow-up computed tomography scan three years after initial presentation showing complete erosion of the stone into the duodenum with gastric distention (white arrow indicating the fistula and green arrow indicating the stone)

Figure 4. Stone retrieved via surgical duodenotomy