Bouveret syndrome: A case report

Abstract

BACKGROUNDBouveret syndrome is a rare complication of cholelithiasis, with only 315 cases reported in the literature between 1967 and 2016. Delay in diagnosis is associated with a high mortality rate. Diagnosis is based upon clinical manifestations, gastroscopy, and imaging studies such as abdominal computed tomography and magnetic resonance cholan-giopancreatography. Endoscopic stone extraction or lithotripsy is the preferred choice for treatment as it is safe and minimally invasive with few complications. However, if endoscopy fails, surgery is required.CASE SUMMARYA 61-year-old female patient presented with recurrent epigastric pain for more than 6 mo. On endoscopy, a large amount of food residue was present in the stomach with multiple stones and ulcers in the antro-pyloric region. Based on these findings, a diagnosis of gastrolithiasis was made. However, computed tomography of the abdomen revealed the correct diagnosis of Bouveret syndrome. Initially, endoscopic treatment was attempted but it failed. Later, she was successfully managed by cholecystectomy with duodenal stone extraction and fistula repair (one-step method). At the last follow-up 6 mo after surgery, the patient was symptom-free.CONCLUSIONBouveret syndrome is a rare complication of gallstones that requires prompt endoscopic or surgical treatment to prevent mortality.

Bouveret syndrome—a rare form of gastric outlet obstruction

“…Bouveret syndrome is even rarer as seen in only 1 to 3% of gallstone ileus [ 1–3 ]. This complication has been reported only 315 times over 50 years between 1967 and 2016 [ 5 ]. Bouveret syndrome specifically describes gastric outlet obstruction caused by an impacted gallstone at the pylorus or proximal duodenum [ 1–6 ].…”

“…Bouveret syndrome specifically describes gastric outlet obstruction caused by an impacted gallstone at the pylorus or proximal duodenum [ 1–6 ]. The ectopic gallstone migrates via a bilioenteric fistula, which develops from chronic inflammation and pressure necrosis [ 5 ]. Cholecystoduodenal fistula is the most common form of bilioenteric fistula, as seen in about 60% of cases [ 4 ].…”

“…Choledochoduodenal and cholecystogastric fistula each comprise about 5% of cases [ 4 ]. Despite the rarity of Bouveret syndrome, its mortality rate is disproportionally high at 12 to 30% [ 3 , 5 , 7 , 8 ]. This is related to its diagnosis typically in a geriatric population with protracted biliary disease, as well as frailty and comorbidities [ 5 , 7 ].…”

“…Despite the rarity of Bouveret syndrome, its mortality rate is disproportionally high at 12 to 30% [ 3 , 5 , 7 , 8 ]. This is related to its diagnosis typically in a geriatric population with protracted biliary disease, as well as frailty and comorbidities [ 5 , 7 ]. The established risk factors for Bouveret syndrome are listed in Table 1 [ 9 , 10 ].…”

“…The Rigler’s triad of gastric outlet obstruction, ectopic gallstone and pneumobilia on radiological imaging is pathognomonic for Bouveret syndrome [ 5 , 7 , 11 ]. This diagnosis can be established on CT, magnetic resonance cholangiopancreato-graphy (MRCP), ultrasound or upper gastrointestinal (UGI) endoscopy.…”