A rarer cause of Bouveret syndrome - A case report

Bouveret syndrome is a rare type of gallstone ileus causing gastric outlet obstruction with high morbidity and mortality risk, and hence important to have a high degree of clinical suspicion on presentation for prompt diagnosis and management.

We present a case of an elderly woman with abdominal pain, haematemesis, and an unremarkable radiograph whose initial emergent endoscopy showed a gastric obstruction and a duodenal diverticulum with a non-bleeding broad based duodenal ulcer. Subsequent computerised tomographic (CT) scan revealed a cholecystoduodenal fistula and gastric outlet obstruction secondary to a 5 cm stone in the duodenojejunal (DJ) flexure. A repeat endoscopy was attempted for endoscopic removal prior to proceeding to open enterolithotomy.

This case highlights the challenges in diagnosis and discusses the latest literature on multimodal management consisting of endoscopy and surgery.

The location of the obstructing stone at the duodenojejunal flexure is extremely rare and therefore will add to world literature on Bouveret syndrome.