P5072 - Bouveret Syndrome: A Rare Cause of Gastric Outlet Obstruction

Aqsa Khan, MD¹, Neil R. Sharma, MD^2
1Parkview Health Center, Fort Wayne, IN; ²Peak Gastroenterolgy, Colorado Springs, CO

Introduction: Bouveret syndrome is a rare cause of gallstone ileus and gastric outlet obstruction. Gallstone ileus is a rare complication of cholelithiasis (0.3-0.5%). Bouveret syndrome accounts for only 1-3% of gallstone ileus. Rigler’s Triad (radiological findings of bowel obstruction, pneumobilia and ectopic gallstone) is the pathognomonic of Bouveret syndrome. We present a case of Bouveret syndrome in a 62-year-old female who presented with epigastric pain and nausea

Case Description/Methods: A 62-year-old Caucasian female with past medical history of hypertension and diabetes presented with epigastric pain and nausea for one month. Pain was intermittent and post prandial initially but progressed to constant and associated with non-bloody emesis. No prior history of Gall stones or Cholecystitis. On examination she had epigastric tenderness and a negative Murphy’s sign. Labs revealed normal AST, ALT, ALP and Bilirubin. CT scan of abdomen and pelvis showed dilatation of the stomach which contains fluid and debris with inflammatory change about the pylorus and proximal small intestine. Air in the biliary tree . (Figure 1 & 2) An EGD showed a gallstone that had eroded through the gallbladder into the duodenal bulb. An attempt was made to retrieve the gallstone; however, failed due to not being able to get any device around the impacted stone. EGD with Lithotripsy and EHL (Electrohydraulic Lithotripter Probe) was tried without any success. The patient ultimately underwent exploratory laparotomy, gastrotomy, removal of stone and temporary Whitzel jejunostomy. Post-operatively patient did well and was discharged home

Discussion: Bouveret syndrome is a rare subtype of gallstone ileus causing gastric outlet obstruction. It could be difficult to diagnose due to non-specificity of symptoms. Most common symptoms are nausea and vomiting (85%) followed by epigastric pain (70%). Biliary enteric fistulas are complications of chronic cholecystitis and cholelithiasis, and they are classified into 5 types depending on the connection between different organs. Our patient presented with a cholecystoduodenal fistula which is the most common type of fistula with a prevalence of ~70%. Surgical vs non-surgical treatment options for Bouveret Syndrome should be tailored according to the patient’s presentation and co-morbid conditions.



Disclosures:


Aqsa Khan, MD¹, Neil R. Sharma, MD². P5072 - Bouveret Syndrome: A Rare Cause of Gastric Outlet Obstruction, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.