P1995 - A Rare Cause of Gastric Outlet Obstruction: Bouveret Syndrome With Duodenal Bulb Involvement

Panagiotis G.. Doukas, MD, Aadhithyaraman Santharaman, MD, Arkady Broder, MD, FACG
Saint Peter's University Hospital / Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ

Introduction: Bouveret syndrome is a rare cause of gastric outlet obstruction due to gallstone impaction from a bilioenteric fistula.

Case Description/

Methods: A 61-year-old male presented with intractable nausea and vomiting. Imaging revealed gastric distention, and upper endoscopy revealed a stenotic mass in the duodenal bulb. Further evaluation identified gallstones and a cholecystoduodenal fistula. The patient clinically improved without needing definitive surgical management.

Discussion: This case highlights the diagnostic challenges of Bouveret syndrome, particularly in the setting of atypical imaging, and emphasizes the role of timely endoscopic assessment in uncovering rare GOO etiologies.


Figure: Figure 1. Imaging evaluation via computed tomography (CT) scan of the abdomen without oral contrast depicting the significantly distended stomach (left) and an intraduodenal foci of air adjacent to the gallbladder (right), likely depicting signs of the chelocystoduodenal fistulization tract.


Figure: Figure 2. Endoscopic evaluation of the pre-pylorus, pylorus and duodenal bulb; image A shows the pre-pyloric region of the stomach depicting nodular mucosa prior to punch biopsy; image B shows the medium-sized infiltrative mass in the duodenal bulb causing severe stenosis; image C and D depict the chelocystoduodenal fistulization tract and yellow stones within the fistula; image E showing the fistula tract after stone migration out of the tract.

Disclosures:
Panagiotis Doukas indicated no relevant financial relationships.
Aadhithyaraman Santharaman indicated no relevant financial relationships.
Arkady Broder indicated no relevant financial relationships.

Panagiotis G.. Doukas, MD, Aadhithyaraman Santharaman, MD, Arkady Broder, MD, FACG. P1995 - A Rare Cause of Gastric Outlet Obstruction: Bouveret Syndrome With Duodenal Bulb Involvement, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.