Bouveret syndrome

Discussion:

One year prior patient received a CT scan demonstrating a large calcified gallstone within the gallbladder (images not shown). One year later the CT scan showed pneumobilia, cholecystoenteric fistula, and gastric outlet obstruction secondary to ectopic gallstone in the proximal duodenum known as Bouveret’s syndrome. Bouveret’s syndrome has the same pathophysiology as gallstone ileus, but instead of the ectopic gallstone causing obstruction/ileus in the distal small bowel (most common terminal ileum) in a rarer event the stone is lodged in the proximal duodenum or gastric pylorus causing gastric outlet obstruction, as in this case. Findings of gallstone ileus or Bouveret’s syndrome may exhibit Rigler’s triad of pneumobilia, ectopic gallstone, and bowel obstruction, like in this case which showed all three findings.

A few weeks later another CT scan was performed because of displacement of the gastrojejunostomy tube which was associated with pneumoperitoneum. The ectopic gallstone within the duodenum was more conspicuous on the latest CT scan.

The ectopic gallstone was treated by endoscopic lithotripsy. Patient’s symptom improved and she was stable at discharge.    

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