Bouveret's syndrome: should we remove the gall bladder?

Area of Science:

• Gastroenterology
• Surgical Case Report

Background:

• Bouveret's syndrome is a rare complication of gallstones causing gastric outlet or duodenal obstruction.
• Treatment is often debated, particularly in elderly patients with significant comorbidities.

Observation:

• A 73-year-old woman presented with coffee ground vomiting, indicative of upper gastrointestinal obstruction.
• Endoscopy revealed a large gallstone in the duodenal bulb; CT confirmed a cholecystoduodenal fistula.

Findings:

• Endoscopic stone removal was unsuccessful.
• Surgical intervention via laparotomy and gastrotomy successfully removed the obstructing gallstone.
• The patient did not undergo immediate cholecystectomy due to her poor medical status.

Implications:

• This case underscores the necessity of surgical management for impacted gallstones in Bouveret's syndrome when endoscopic methods fail.
• Delayed cholecystectomy is a crucial consideration for preventing recurrence, even after initial surgical relief.
• The patient's later presentation with pancreatitis highlights the long-term risks associated with untreated cholecystoduodenal fistulas.