P0216 - Bouveret Syndrome: A Consequential Complication of Gallstone Disease

Joseph Jones, MD¹, Usama Sakhawat, MD¹, Ahmed Shehadah, MD², Amanke Oranu, MD²
1United Health Services, Wilson Medical Center, Johnson City, NY; 2United Health Services, Wilson Medical Center, Binghamton, NY

Introduction: Bouveret syndrome is diagnosed when a gallstone, via a bilioenteric fistula, becomes impacted in the gastric antrum or proximal duodenum, causing gastric outlet obstruction (GOO). This is a rare phenomenon, as gallstone disease has a prevalence of 10-15% in the United States, with bilioenteric fistulas developing in 1-2% of patients. The most common site of bilioenteric fistula formation is between the gallbladder and the duodenum, with the most common symptoms being abdominal pain, nausea, and diarrhea; with GOO only occurring in 1-3% of cases. Despite being a rare diagnosis, Bouveret syndrome should be considered in the appropriate clinical setting, as management can be complex, requiring a multidisciplinary approach.

Case Description/

Methods: An 80-year-old male with medical history of coronary artery disease, congestive heart failure, atrial fibrillation on anticoagulation, and ulcerative colitis, presented to the emergency department after two syncopal events. He was hypotensive, prompting a trauma code, given his fall while on anticoagulation. Abdominal computed tomography revealed a 27 mm calculus in the duodenal lumen and a non-dependent gas bubble in the gallbladder lumen. He required a massive transfusion protocol and intubation. An esophagogastroduodenoscopy revealed a 20 mm cholecystoduodenal fistula in the first portion of the duodenum. Bleeding from a lesion in the body of the gallbladder was addressed with argon plasma coagulation and application of a hemostatic clip. Before coordination of transfer for hepatobiliary surgical evaluation, the patient developed gallstone ileus for which he underwent exploratory laparotomy. Given his critical condition and poor prognosis, the patient's family decided to pursue palliative care, and he later expired.

Discussion: Bouveret syndrome is a rare complication of gallstone disease with serious clinical
consequences. Delayed or misdiagnosis is common, as presenting symptoms are nonspecific.
In this case, incidental findings from the trauma work up assisted in making an early diagnosis. Once
diagnosed, multidisciplinary management requires considerations be made for endoscopy,
surgery, and lithotripsy. Unfortunately, despite treatment, mortality ranges from 12-30%, owing to
an increased prevalence in frail and elderly patients. In closing, it is because of the vague presenting
symptoms, the complex management, and the high mortality rates, that clinicians should be familiar
with the pathophysiology and diagnosis and Bouveret syndrome.

Disclosures:
Joseph Jones indicated no relevant financial relationships.
Usama Sakhawat indicated no relevant financial relationships.
Ahmed Shehadah indicated no relevant financial relationships.
Amanke Oranu indicated no relevant financial relationships.

Joseph Jones, MD¹, Usama Sakhawat, MD¹, Ahmed Shehadah, MD², Amanke Oranu, MD². P0216 - Bouveret Syndrome: A Consequential Complication of Gallstone Disease, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.