Bouveret's Syndrome: A Case-Based Review, Clinical Presentation, Diagnostics and Treatment Approaches

Bigger Than a Hen's Egg: A Case of Bouveret Syndrome

Bouveret syndrome, a rare complication of cholelithiasis resulting in gallstone ileus, presents diagnostic and therapeutic challenges due to its low incidence and nonspecific symptoms. We report a case of Bouveret syndrome in a middle-aged male without significant medical history, emphasizing the need for heightened clinical suspicion. Diagnostic imaging, including computed tomography and upper endoscopy, revealed gastric outlet obstruction and a cholecystoduodenal fistula. Treatment involved unsuccessful endoscopic lithotripsy followed by surgical intervention. This case underscores the importance of interdisciplinary collaboration for successful management. With no standardized approach, individualized treatment strategies, including endoscopic and surgical interventions, are crucial for favorable outcomes in Bouveret syndrome.

The Rolling Stone: Bouveret Syndrome Requiring Open Gastrotomy After Failing Electrohydraulic Lithotripsy

Bouveret syndrome (BS) is an extremely rare form of gallstone ileus where a stone travels through a biliary-enteric fistula and causes gastric outlet obstruction. A 92-year-old male presented with gastric outlet obstruction secondary to an impacted gallstone in the duodenal bulb seen on imaging. Endoscopic therapy failed twice due to the immense gallstone size, and an open gastrotomy was required to remove the stone. The procedure was successful; however, the patient, unfortunately, passed away days after the operation due to other hospital illnesses. BS should be considered in patients with advanced age and significant comorbidities presenting with gastric outlet obstruction.

Cholecystogastric fistula in Bouveret syndrome: Case report and literature review

INTRODUCTION AND IMPORTANCE

Cholelithiasis is the benign bile pathology with major prevalence. A rare condition has been described, when a stone migrates through the duodenum causing small bowel obstruction (SBO), it's known as Bouveret syndrome, and it's attributed to almost 5% of SBO. Just 2% of the cases present with the migration of the stone through a fistula between gastric chamber and gallbladder, with limited reports in the literature.

CLINICAL FINDINGS

We present a case of an 87-year-old male with Bouveret syndrome and a cholecystogastric fistula with a stone in the gastric chamber who underwent laparoscopic gastrotomy to resolve the clinical case.

CONCLUSION

Bouveret syndrome remains to be a rare condition in benign bile pathology. Individualized treatment should be performed and multidisciplinary approach leads to improved outcomes for the patient.

A Unique Presentation of Bouveret's Syndrome: Two Large Gallstones Obstructing Both the Gastric Outlet and the Common Bile Duct Simultaneously

Bouveret's 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 and is infrequent. We describe such a unique case that a female patient presents with Bouveret's syndrome and concomitant common bile duct obstruction by a second gallstone. The decision over its surgical management is complicated, based on risk factors, clinical presentations, radiographic evidence, surgical risk assessment, and specific considerations tailored to individual case. Because of her stable clinical picture and low surgical risk, we proceeded with stone extractions, fistula take-down, and common bile duct exploration in a one-stage procedure. Her postoperative course was complicated by bile stained drainage through closed suction drain that resolved with conservative management.