Concurrent Bouveret's Syndrome and Gallstone Ileus: A Rare Case of Dual-Site Obstruction in Gallstone Disease

Bouveret's syndrome is a rare cause of gastric outlet obstruction, resulting from gallstone migration into the duodenum via a biliary-enteric fistula. Even rarer is its coexistence with distal gallstone ileus. We report the case of an elderly woman presenting with gastric outlet obstruction who was found to have dual-site obstruction caused by two impacted gallstones. Despite multidisciplinary management involving imaging, endoscopy, and surgery, her postoperative course was complicated by sepsis and multiorgan failure, leading to death. This case underscores the severe morbidity and mortality associated with advanced gallstone disease in elderly patients with comorbidities and highlights the challenges in timely diagnosis and treatment.