Bouveret Syndrome: Gastric Outlet Obstruction Secondary to Cholecysto-duodenal Fistula

Abstract

Background: Gastric outlet obstruction (GOO) due to gallstone disease, known as Bouveret syndrome, is a rare but serious complication typically seen in elderly patients. Early recognition and appropriate management are crucial to prevent morbidity. Gastric outlet obstruction (GOO) is an uncommon complication of gallstone disease, often resulting from gallstone migration through a cholecysto-duodenal fistula. Aim: The case report aims to examine Bouveret syndrome, the gastric outlet obstruction secondary to cholecysto-duodenal fistula. Methods: A 29-year-old female presented with a 15-day history of recurrent mild upper abdominal pain, nausea, and non-bilious vomiting. Imaging and endoscopy revealed chronic cholecystitis with a large gallbladder calculus causing GOO via a cholecysto-duodenal fistula. Endoscopic retrieval attempts were unsuccessful. Results: The patient underwent open cholecystectomy, duodenotomy for stone removal, and gastrojejunostomy. Postoperative recovery was uneventful, with complete resolution of symptoms. The patient’s recovery was uneventful.  Follow-up at 2 months showed complete resolution of symptoms with no evidence of recurrence or complications. Conclusions: Bouveret syndrome, though uncommon, should be considered in cases of gastric outlet obstruction and a history of Gallstone disease. In younger patients, surgical management with definitive fistula closure is advisable to prevent recurrence and long-term complications. In elderly or high-risk patients, endoscopic extraction with conservative management of the fistula may be appropriate when stone clearance is complete.