Bouveret syndrome is characterized by the migration of a gallstone through a cholecystenteric fistula into the proximal duodenum resulting in gastric outlet obstruction.
A 79-year-old female presented with symptoms of gastric outlet obstruction and was diagnosed with Bouveret syndrome.
Patients with Bouveret syndrome present with varied, non-specific symptoms that may include emesis, abdominal pain, anorexia, and abdominal distention.
2,3,5,6,14) Bouveret syndrome accounts for 1-3% of duodenal obstruction cases.
Bouveret syndrome is considered a distinct clinical entity from gallstone ileus due to the proximal site of the obstructing stone.
The clinical features of Bouveret syndrome can be varied and nonspecific; however, certain complaints tend to recur.
The confirmation of a diagnosis of Bouveret syndrome using plain abdominal films is dependent on the observation of Rigler's tetrad as delineated in his 1941 article (17) (Table 1).
In another series of 40 cases of Bouveret syndrome, pneumobilia was visualized in less than half.
23) Pneumobilia is visualized in 60%, gallstones in 50%, and duodenal or gastric distension in 33% of cases of Bouveret syndrome.
15) The visualization of a gallstone on gastroscopy appears to be the only significant differentiating factor between the gastric outlet obstruction of Bouveret syndrome and the jejunoileal obstruction of the classic gallstone ileus.
The management of Bouveret syndrome is similar to the paradigm established for gallstone ileus.