Choleduodenal fistula with gastric outlet obstruction

Abstract

Bouveret's syndrome, cholecystoduodenal fistula with gastric outlet obstruction secondary to an impacted gallstone, is a rare but serious complication of cholelithiasis. We report the case of a 69-year-old woman who presented with epigastric pain and vomiting in whom cross-sectional imaging revealed a duodenal mass with cholecystoduodenal fistula and pneumobilia. Endoscopic evaluation identified a large gallstone obstructing the pyloric channel. She underwent laparotomy and stone extraction with pyloroplasty, had an unremarkable recovery. She was asymptomatic at 15 months follow-up.

Gastric Outlet Obstruction after Subtotal Cholecystectomy

“…Gastric outlet or proximal duodenal obstruction is a known manifestation of gallstone disease when a bilioenteric fistula allows a gallstone to enter and obstruct the duodenum, a phenomenon known as Bouveret's syndrome. 3 A previously reported case describes a patient who initially presented with uncomplicated cholecystitis, did not receive treatment, and later developed gastric outlet obstruction caused by mechanical compression from inflammation of the gallbladder, liver, omentum, and duodenum. 4 In that case, however, the offending gallstone was recovered outside the gallbladder and the patient had not previously undergone subtotal cholecystectomy.…”