Revision 17 for 'Bouveret syndrome'

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Bouveret syndrome

Bouveret syndrome refers to a gastric outlet obstruction secondary to impaction of a gallstone in the pylorus or proximal duodenum. It is therefore a very proximal form of gallstone ileus

Clinical presentation

Bouveret syndrome occurs most commonly in elderly women. The presenting clinical situation is variable and nonspecific but often includes nausea, vomiting, and epigastric pain.

Radiographic features

Plain film and CT

Rigler triad (bowel obstruction, pneumobilia, and an ectopic gallstone) is seen only in a subset of patients. In cases where the offending gallstone is identified, its size (and hence the likelihood of mechanical obstruction) may be underestimated if only the calcified portion of the stone is measured 4.

Ultrasound

Sonography may detect the presence of a cholecystenteric fistula, residual gallstones and gastric outlet obstruction.  

Treatment and prognosis

Early diagnosis is important because mortality is high, with reported figures ranging between 12-33%.

Endoscopy is preferred as a therapeutic option because removal may be performed with mechanical, electrohydraulic, or laser lithotripsy.

Surgery often is not desirable as the patients are often poor surgical candidates secondary to concomitant illnesses and advanced age.

History and etymology

Named after Leon Bouveret, French internist (1850-1929).

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