Bouveret syndrome occurs most commonly in elderly women. The presenting clinical situation is variable and nonspecific but often includes nausea, vomiting, and epigastric pain. A history of gallstone disease will only be present in a minority of patients 5.
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.
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).