Bouveret syndrome refers to a gastric outlet obstruction secondary to impaction of a gallstone in the pylorus or proximal duodenum. Thus, it can be considered a very proximal form of gallstone ileus. Gallstone-induced ileus is a rare complication of cholelithiasis, and gastric outlet obstruction is an even more rare variant. Bouveret syndrome is a gastric outlet. Bouveret syndrome is a very uncommon form of gallstone ileus caused by the passage and impaction of a large gallstone through a cholecystoduodenal fistula into the duodenum, resulting in gastric outlet obstruction. It was first described in by Beaussier [1, 2].


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Gallstone ileus, Bouveret's syndrome, Gastric outlet obstruction Bouveret's syndrome describes gastric outlet bouveret syndrome caused by large gallstones that reach the duodenal bulb and get lodged there through a biliodigestive fistula.

It is a rare and atypical variant of gallstone ileus that typically occurs in elderly patients with multiple medical comorbidities.

Because of its rarity and atypical nature the diagnosis of Bouveret's syndrome is often delayed or overlooked.

The aim of bouveret syndrome this case and following it by a brief overview of current diagnostic and therapeutic modalities is to heighten awareness of this overlooked clinical entity as a timely diagnosis and management. This heightened awareness is the key to improving prognosis.

Case Presentation A year-old male patient who is a known case of diabetes mellitus and hypertension presented to the outpatient surgical clinic complaining of recurrent attacks of biliary colic bouveret syndrome 1-year duration. The diagnosis of cholelithiasis was confirmed by abdominal ultrasound that revealed a single large gallstone.

The patient was then planned for elective laparoscopic cholecystectomy. A week prior to the date of his scheduled surgery he presented to the accident and emergency department with upper gastrointestinal bleeding and was in shock.

He was promptly resuscitated with fluids and 2 units of packed red blood cells and admitted to the intensive care unit.


A gallstone in the 2nd to 3rd part of the duodenum arrow. A nasogastric tube was placed to decompress the stomach. Initial treatment included administration of fluids, bouveret syndrome and antibiotics.

Bouveret syndrome

For further topographic information a gastrografin meal was performed. A large gallstone was visualised in the 2nd bouveret syndrome 3rd part of the duodenum.

The gallbladder, the cystic duct and the cholecystoduodenal fistula as well as a duodenal diverticulum of the 3rd part were well visualised Figures 6 and 7.

Five bouveret syndrome after intake of the oral contrast all the anatomic elements are well visualised: Fifteen minutes after intake of the oral contrast a the evacuation of the gallbladder is well seen as well as b the dilatation of the filled up with contrast duodenum proximally to the impacted gallstone and c the slight passage of the gastrografin distally to the gallstone in the 4rth part and jejunum.

The patient was transferred in the endoscopic unit where a gastroduodenoscopy was performed.

The fistula orifice was seen Figure 8 as well as the proximal side of bouveret syndrome gallstone Figure 9. A cholecystoduodenal fistula orifice noticed in the superior duodenal wall arrow. The proximal side of a large gallstone impacted bouveret syndrome the 2nd to 3rd part of the duodenum arrow.

Bouveret syndrome | Radiology Reference Article |

Endoscopic removal and mechanical lithotripsy were attempted using different skills and equipment, but all efforts failed Figure Figure 10 Surgical treatment was decided. Due to serious comorbidity the patient bouveret syndrome high thoracic epidural anaesthesia.

A laparotomy with midline incision was performed. The gallbladder was found collapsed and the cholecystoduodenal fistula was identified.

An initial effort for proximal removal towards the stomach was unsuccessful. With gentle milking movements distal removal was achieved in the first part of the jejunum right after the ligament of Treitz Figure No further removal was feasible.

A jejunotomy and successful removal of the gallstone were performed Figure The size of the extracted calculus was 5. The jejunotomy was sutured in two layers.

  • Bouveret's Syndrome: An Overlooked Diagnosis. A Case Report and Review of Literature
  • Bouveret Syndrome—The Rarest Variant of Gallstone Ileus: A Case Report and Literature Review
  • Bouveret's Syndrome: An Overlooked Diagnosis. A Case Report and Review of Literature
  • StatPearls [Internet].