Bouveret Syndrome Presenting as Duodenal Bulb Stenosis and Gastric Outlet Obstruction: A Case Report

Bouveret syndrome, or gallstone obstruction of the duodenum, is a rare cause of gastric outlet obstruction, where gallstones migrate through a bilioenteric fistula and obstruct the pylorus or duodenum. Here, we present a case of a 61-year-old man who presented with intractable nausea and vomiting. Initial imaging, such as computed tomography of the abdomen and pelvis, showed gastric distention without an obvious obstructing lesion, and a subsequent upper endoscopy revealed a cholecystoduodenal fistula filled with gallstones, posterior to a stenotic region in the duodenal bulb. The calculi were spontaneously evacuated, the patient's symptoms resolved, and the patient was referred for surgical management. This case highlights the diagnostic challenges of Bouveret syndrome, particularly in the setting of atypical imaging, and emphasizes the importance of timely endoscopic assessment in uncovering rare etiologies of gastric outlet obstruction.