Bouveret syndrome

Discussion:

Bouveret syndrome is a rare form of gallstone ileus caused by the passage and impaction of a large gallstone through a cholecystoduodenal fistula into the duodenum. In 1896 the French physician Leon Bouveret published two cases of gastric outlet obstruction due to gallstone stranding in the duodenal bulb. It most commonly affects elderly women with a mean age of 68.6 years. The presenting clinical situation is variable and nonspecific but often includes nausea, bilious vomiting, and epigastric pain.

The most common CT findings include pneumobilia,  gallstone impacted in the proximal portion of the duodenum and distended stomach (not shown here due to the presence of nasogastric-tube).

If the patient has no other complications Endoscopy is a preferred method of choice of removing the impacted stone. As in our case combined with cholecystitis surgical treatment is required.

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