Volume 13, Issue 1
Original Article / Published: September 2025
DOI: https://www.doi.org/10.57045/jemis/1310925.pp80-84
El-Tal L., M. Rusenov, P. Drundov
Acibadem City Clinic Tokuda Hospital, Sofia
Department of liver, biliary, pancreatic and general surgery
Abstract
Introduction: Bouveret‘s syndrome is defined as an obstruction caused by the migration of a stone after the formation of a cholecysto-duodenal fistula. It is a rare form of small bowel obstruction that results from gallstone disease and causes significant rates of morbidity and mortality (up to 30%). The purpose of this clinical case report is to raise awareness of this neglected clinical entity to ensure timely diagnosis and treatment for future patients.
Case presentation: It concerns a 68-year-old woman with a history of upper abdominal pain accompanied by abdominal distension and vomiting. After performing laboratory and imaging studies (CT) of abdominal organs, mechanical small intestinal ileus, dilated extrahepatic bile ducts (ECB) and aerobilia were established. An ultrasound examination (US) was also performed, in which small intestinal obstruction from a gallstone was detected.
Clinical discussion: Bouveret syndrome is an uncommon form of gallstone ileus caused by large gallstones reaching the duodenum through a biliodigestive fistula. X-ray imaging usually reveals Rigler’s triad: 1. small bowel obstruction; 2. Gallstone outside the gallbladder; 3. Air in the bile ducts. Computed tomography can also reveal the presence of a fistula. Magnetic resonance cholangiopancreatography (MRCP) can be used to make a correct diagnosis. The main goal in the treatment of Bouveret syndrome is to remove the obstructing gallstone. The main methods of treatment are surgical intervention – conventional or laparoscopic.
Conclusion: Bouveret syndrome is a rare but potentially life-threatening condition of gastric outlet obstruction caused by large gallstones. Treatment may be delayed due to non-specific symptoms and prolonged diagnosis.
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Keywords:
Bouveret syndrome, cholelithiasis, A clinical case report
How to cite this article:
El-Tal L., M. Rusenov, P. Drundov. Bouveret syndrome: a multimodal approach to complicated gallstone disease – a clinical case report. Journal of Endourology and Minimally Invasive Surgery (Bulgaria), 2025; 13(1): 80-84
Corresponding author:
Dr. Tanislava Kirova
Military Medical Academy, Sofia
Email: tanislava.kirova@gmail.com