In addition, cases of gallstones obstructing the gastric output have been reported; this was called Bouveret syndrome
after the name of Leon Bouveret who reported two cases for the first time in 1896 (4,5).
Major benign causes of gastric outlet obstruction are peptic ulcer diseases, gastric polyps, ingestion of caustics, pyloric stenosis, congenital duodenal web, gallstone obstruction (Bouveret syndrome
), pancreatic pseudocyst, and bezoars.
Because of the older age and significant comorbid conditions in patients presenting with Bouveret syndrome, the mortality (60%) and morbidity (12-33%) are relatively high and necessitate early and quick removal of the stone by the least invasive procedure [5, 10].
To the best of our knowledge, this is the first reported case of Bouveret syndrome secondary to choledochoduodenal fistula.
In our case the patient was having impacted gallstone at the duodenal ulcer so he presented with symptoms of Bouveret syndrome. In Bouveret syndrome, findings on presentation are often nonspecific with nausea, distention, and abdominal pain being the most common .
Given the elderly patient population of Bouveret syndrome with significant comorbid conditions, sometimes significant delay in diagnosis requires safe and quick removal of stone to relive the obstruction.
In our case beside treating the Bouveret syndrome the other management challenge was duodenal peptic ulcer complicating choledochoduodenal fistulas.
It is important to be aware of Mirizzi's syndrome as it is a cause of bowel obstruction.(1) Bouveret syndrome
is another rare complication of cholelithiasis with an incidence of 1-3% of those with gallstone ileus.(2) It occurs when a gallstone passes through a cholecystoduodenal fistula and lodges in the pylorus or proximal duodenum causing a gastric outlet obstruction.(3)
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. This report describes the symptoms, diagnosis, and management of Bouveret syndrome, as well as its prevalence and differentiation from gallstone ileus.
Patients with Bouveret syndrome present with varied, non-specific symptoms that may include emesis, abdominal pain, anorexia, and abdominal distention.
Bouveret syndrome, in contrast to gallstone ileus, is characterized by the cephalad or proximal migration of a gallstone into the duodenum resulting in a persistent gastric outlet obstruction as originally described by the French surgeon Leon Bouveret in 1896.