A Rare Case of Gallstone Ileus: Bouveret Syndrome Presenting with Concurrent Gallstone Coleus

Abstract

Background. Bouveret syndrome and gallstone coleus are two rare subsets of gallstone ileus. Bouveret syndrome involves a gastric outlet obstruction, whereas gallstone coleus involves an obstruction of the large intestine. Both of the conditions are caused by gallstones, which migrated from the gallbladder via the fistulae. Due to its rarity, only few cases were reported for each condition. The current case describes an even rarer case of Bouveret syndrome and gallstone coleus presenting together. The case report will hopefully provide better understanding of the disease presentation and hence, lead to early diagnosis and management. Case. Ms. B is an 86-year-old woman of Italian background who presented to our emergency department with worsening symptoms of bowel obstruction. Her past clinical history included Kaposi sarcoma, hypertension, osteoarthritis, and vitamin D deficiency with surgical history including caesarean section and tonsillectomy. On her imaging, she had two large gallstones, one in the proximal duodenum and one in the distal colon. It also showed gastric dilatation and gas in the gall bladder. She was subsequently diagnosed with Bouveret syndrome with concurrent gallstone coleus. The laparotomy revealed two points of gallstone obstruction at the first part of the duodenum and at the distal sigmoid colon. Her postoperative recovery was uncomplicated. She was discharged to the care of her family and followed up in the general surgery clinic. Conclusion. The current case report describes a unique presentation of Bouveret syndrome where an additional gallstone was found simultaneously in the sigmoid colon causing the obstruction. By introducing this novel case of having two different subsets of gallstone ileus simultaneously, there will be a better understanding of both conditions and hopefully improve our scope of practice.

Cholecystogastric fistula in Bouveret syndrome: Case report and literature review

“…However, the endoscopic approach beyond being an operator dependent procedure and requiring specialized tools, is limited to smaller calculus, usually less than 3 cm. Park, et al [16] , [17] , [18] present that up to 91% of endoscopic and percutaneous extraction attempts fail, requiring subsequent surgical approach, as happened in our case, despite having a specialized team in endoscopic extraction technique [16] , [17] , [18] . On the other hand, the surgical approach includes laparoscopy and laparotomy techniques with gastrotomy, pylorotomy, duodenotomy in those cases in which the mobilization of the stone is easy and there is no excessive ulceration of the mucosa [2] .The performance of cholecystectomy and fistula repair have been also described, however given the increase in morbidity and mortality in older patients it is recommended to carry out two differed surgical procedures [19] , [20] , [21] .…”

“…Treatment of Bouveret syndrome can be both endoscopic and surgical [3] , [4] , [5] , [16] , [17] , [18] . There are multiple modalities for the treatment of Bouveret syndrome.…”

Two Sites of Obstruction with Gallstones: A Case Report of Bouveret Syndrome with a Concurrent Biliary Ileus

“…Multiple stones may be retrieved in the digestive tract [5][6][7], but recurrence is uncommon [2,3,8]. Nevertheless, simultaneous dual-site obstruction is very rare [9][10][11][12], with only two earlier reported cases involving Bouveret syndrome in the literature [7,13]. In the present report, we describe an interesting case of Bouveret syndrome causing gastric outlet obstruction with a simultaneous obstructive gallstone in the jejunum.…”

Gallstone Ileus Caused by Migration of Gallstone Through Cholecystoduodenal Fistula Resulting in Small Bowel Obstruction

“…Therapeutic endoscopy is an option for patients with colonic gallstone ileus or Bouveret syndrome, but it is technically challenging and unsuccessful in up to 91% of cases. Surgery is typically required [ 17 , 18 , 19 ].…”