Ann Hepatobiliary Pancreat Surg.  2021 Feb;25(1):139-144. 10.14701/ahbps.2021.25.1.139.

Bouveret syndrome: A series of cases that illustrates a rare complication of chronic cholelithiasis

• Runyan B
• Caparelli ML
• Batey J
• Allamaneni S
• Perlman S

• KMID: 2513188
• DOI: http://doi.org/10.14701/ahbps.2021.25.1.139

Abstract

Bouveret syndrome is defined as gastric outlet obstruction secondary to the impaction of a large gallstone in the proximal gastrointestinal tract. The obstruction occurs as result of a bilio-enteric or bilio-gastric fistula. This clinical entity is a rare variant of the more commonly recognized gallstone ileus, which tends to cause small bowel obstruction of the terminal ileum. The typical presentation of Bouveret syndrome consists of nausea, vomiting and abdominal pain secondary to obstruction. Diagnosis often requires radiographic imaging with computed tomography, which typically shows pneumobilia or a cholecystoduodenal fistula. Herein is a series consisting of three cases of Bouveret syndrome involving a bilioenteric, cholecystoduodenal, and choledochoduodenal fistula, respectfully, all of which required operative management. A discussion of the current literature regarding management of this rare syndrome follows.

Keyword

Cholecystoduodenal fistula; Gallstone ileus; Obstruction

Figure

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  Fig. 1 Computed tomography images of an enlarging intraluminal gallstone. Axial view demonstrating interval enlargement of a gallstone within the gallbladder lumen. Arrow points to gallstone.

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  Fig. 2 Computed tomography images showing jejunal gallstone. Coronal view demonstrating distal migration of the gallstone from the duodenum to the jejunum. Arrow points to gallstone.

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  Fig. 3 Gross pathologic specimen from surgery. This image demonstrates the gross pathology of a large gallstone measuring 5 cm.

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  Fig. 4 Gross view of enterotomy created for stone extraction.

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