Bouveret Syndrome: A rare form of gallstone ileus a case report

• Published in: International journal of surgery case reports Vol. 116; p. 109438
• Main Authors: Atri, S., Elaifia, R., Sebai, A., Hammami, M., Haddad, A., Kacem, J.M.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Ltd 01-03-2024
• Subjects: Case report; Cholecystoduodenal fistula; Endoscopy; Gastric outlet obstruction; Laparotomy; Case report; Cholecystoduodenal fistula; Endoscopy; Gastric outlet obstruction; Laparotomy
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2024.109438

Bouveret Syndrome, a rare form of gallstone ileus, involves the migration and impaction of a gallstone in the duodenum or stomach, causing gastric outlet obstruction. Early intervention and a comprehensive care plan are essential for favorable outcomes.
This article presents a case of an 82-year-old female with a history of coronary artery disease and untreated gallstones. The patient experienced nausea, vomiting, and abdominal pain for two weeks. Diagnostic procedures revealed a cholecystoduodenal fistula with a 4 cm stone lodged at the duodenojejunal angle. For our patient the gallstone was moved to the jejunum, followed by enterotomy and a latero_lateral gastroenteroanastomosis.
The rarity of Bouveret Syndrome and its nonspecific symptoms make diagnosis challenging, necessitating differentiation from other gastrointestinal disorders. Esophagogastroduodenoscopy (EGD) and imaging, such as computed tomography (CT), play crucial roles in diagnosis. In this case, the EGD did not show gallstones up to the second part of the duodenum.
Management involves a multidisciplinary approach, with supportive care for stabilization and the primary goal of removing the impacted stone. Treatment options include endoscopic, surgical, or lithotripsy techniques. Bouveret Syndrome poses challenges due to its rarity, leading to delayed diagnosis. Prognosis varies based on factors such as stone size, location, and overall patient condition.
Through this case we emphasizes the importance of awareness, timely diagnosis, and appropriate management, with EGD and CT scan playing key roles in diagnosis. Surgical intervention remains a viable treatment option when endoscopic approaches are unavailable. The article highlights the controversial nature of fistula repair in Bouveret Syndrome.
•Bouveret Syndrome, a rare form of gallstone ileus causing gastric outlet obstruction.•Esophagogastroduodenoscopy (EGD) and especially computed tomography (CT) showing Rigler triad, play crucial roles in diagnosis•Bouveret Syndrome poses challenges due to its rarity, leading to delayed diagnosis.•Treatment options include endoscopic, surgical, or lithotripsy techniques.•Prognosis varies based on factors such as stone size, location, and overall patient condition.