Division
East Florida
Hospital
HCA Florida Aventura Hospital
Specialty
Internal Medicine
Document Type
Poster
Publication Date
2025
Keywords
gastric outlet obstruction, bouveret syndrome, gallstones
Disciplines
Digestive System Diseases | Internal Medicine
Abstract
Introduction: Bouveret syndrome is characterized by a gallstone passing through a bilioenteric fistula causing gastric outlet obstruction and represents 1-3% of gallstone obstructions. Fistualization occurs when chronic inflammation from the gallstone on the gallbladder wall leads to ischemia and perforates into the bowel. Over 60% of patients with cholelithiasis are asymptomatic. Biliary colic is the most common presentation in symptomatic patients. A biliary fistula occurs in 3-5% of cases and just 7-10% of these cases lead to gallstone ileus. The highest prevalence is among women of advanced age. Typical presentation is with general symptoms of nausea/vomiting and vague abdominal pain. Although morbidity and mortality from this condition have decreased, they remain high, likely due to comorbidities in the geriatric population. Case Presentation: Our patient is a 32 y/o female with a history of intellectual disability who presented with abdominal pain, non-bloody emesis, and inability to tolerate PO for two days. Initial CT abdomen/pelvis demonstrated gas filled structure in the gallbladder fossa. Hepatobiliary scan noted scattered intraperitoneal gas suggestive of perforated viscus. Patient began having bloody emesis and was transferred to the ICU. CT abdomen/pelvis with IV contrast was ordered and was significant for a 3x3x4 cm noncalcified soft tissue density in the duodenum. An EGD was performed as there was concern for a foreign body, and there was evidence of gastric outlet obstruction with diffuse severe ulceration of the stomach and a large ulcer with fistula in the duodenal bulb with a 3 cm impacted stone. General surgery was consulted for removal of the impacted stone. The patient underwent an exploratory laparotomy and was found to have a cholecystoduodenal fistula with gastric outlet obstruction. An open cholecystectomy, repair of the cholecystoduodenal fistula, extraction of the gallstone was performed. The patient tolerated the procedure well. Her condition improved and she was eventually discharged home.
Original Publisher
HCA Healthcare Graduate Medical Education
Recommended Citation
Tummala, Mahesh; Devine, Adam; Tummala, Akash; and Concepcion-Perez, Livasky, "A Case of Gastric Outlet Obstruction Secondary to A Gallstone" (2025). East Florida Division GME Research Day 2025. 47.
https://scholarlycommons.hcahealthcare.com/eastflorida2025/47