Surgical treatment of Bouveret Syndrome without completion cholecystectomy

Bouveret syndrome, the rarest variant of gallstone ileus, occurs due to the passage of a gallstone into the gastrointestinal tract via a bilioenteric fistula, leading to gastric outlet obstruction. This condition represents less than 0.1 % of all mechanical bowel obstructions, predominantly affecting elderly females. Its nonspecific symptoms, including nausea, vomiting, and abdominal pain, often result in delayed diagnosis and significant mortality rates ranging from 12 % to 30 %. Historically, management involves a two-stage surgical approach: initial stone removal followed by interval cholecystectomy and fistula repair to prevent recurrence.

This report presents two cases of younger patients with Bouveret syndrome managed with a single-stage surgical approach consisting of gallstone removal without subsequent cholecystectomy or fistula repair. Both patients remained symptom-free for two years postoperatively.

These findings challenge the necessity of routine interval cholecystectomy and fistula closure, particularly in patients without recurrent biliary symptoms. We discuss the implications of a simplified surgical strategy, highlighting the potential for spontaneous fistula closure or adaptation of bile drainage pathways.

While current literature supports interval surgery for younger patients to mitigate long-term risks, these cases suggest that selective management may reduce morbidity without compromising outcomes. Further research is needed to refine guidelines for the surgical management of Bouveret syndrome.