Surgical Duodenotomy Following Untreated Bouveret Syndrome

Area of Science:

• Gastroenterology
• Surgical Gastroenterology

Background:

• Bouveret syndrome is a rare clinical presentation of gallstone ileus, characterized by a gallstone eroding into the duodenum via a cholecystoduodenal fistula, leading to gastric outlet obstruction.
• It is distinguished from typical gallstone ileus by the stone's location in the stomach or duodenum, rather than the small intestine.
• Clinical manifestations commonly include nausea, vomiting, and epigastric pain, with radiographic findings often revealing pneumobilia.

Observation:

• The patient presented with classic symptoms of nausea, vomiting, and abdominal pain, with radiographic imaging revealing pneumobilia, a hallmark sign.
• Diagnosis and subsequent treatment were significantly delayed due to the patient's initial preference for surgical intervention over endoscopic procedures.

Findings:

• The case illustrates the challenges in managing Bouveret syndrome when endoscopic stone extraction attempts fail.
• Successful treatment was ultimately achieved through a duodenotomy procedure after conservative measures and initial endoscopic attempts proved unsuccessful.

Implications:

• This case underscores the importance of timely and appropriate management of Bouveret syndrome, balancing patient preferences with optimal clinical outcomes.
• It highlights the potential need for surgical intervention, such as duodenotomy, when endoscopic approaches are not feasible or fail in cases of complex gallstone obstruction.