Bouveret Syndrome: Uncommon Form of Gallstone Ileus

Abstract

A rare complication of cholelithiasis usually presents with signs and symptoms of gastric outlet obstruction, secondary to an acquired fistula between gallbladder and either the duodenum or stomach.Its diagnosis is often delayed or overlooked.Despite medical advances over the last 350 years, gallstone ileus is still associated with high rates of morbidity and mortality.A 65-year-old diabetic woman was presented to the emergency with an acute proximal small bowel obstruction with upper gastrointestinal bleeding (one melenas episode).Abdominal CT Scan led to diagnosis of stasis stomach upstream to a large gallstone obstruction in the third portion of the duodenum due to cholecysto-duodena fistula as the origin of gallstone migration.Surgical treatment was removed through duodenotomy since the stone milking from duodenum to jejunum was not possible (the calculus was stuck into the treitz angulus); No attempt was made neither to repair the choledocho-duodenal fistula.The patient passed away three days after, following an ketoacidotic coma which escaped resuscitation measures.