SHM Converge Scientific Abstract ePoster Gallery-A Rock in a Hard Place: Bouveret Syndrome

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This case describes <strong>Bouveret syndrome</strong>, a rare and dangerous complication of gallstone disease. Bouveret syndrome occurs when a <strong>large gallstone passes through a cholecystoenteric fistula into the pylorus or duodenum</strong>, causing <strong>gastric outlet obstruction</strong>. It is a form of gallstone ileus with <strong>high morbidity and mortality</strong>.

The patient was an <strong>84-year-old woman</strong> with multiple chronic illnesses, including diabetes, hypertension, osteoporosis, prior stroke, and rheumatoid arthritis. She was first hospitalized for <strong>acute cholecystitis</strong>, treated with antibiotics and a <strong>percutaneous cholecystostomy tube</strong>. After the tube was accidentally removed during rehabilitation, surgery was deferred because of her frailty. Three months later, she returned with <strong>abdominal pain, nausea, vomiting, abdominal distention, and decreased bowel sounds</strong>.

Imaging showed a <strong>large gastric bubble on x-ray</strong> and <strong>CT evidence of fistulization between the gallbladder and the gastric antrum/duodenum</strong>, with gallstones extending into the stomach and duodenum, confirming <strong>gastric outlet obstruction</strong> from Bouveret syndrome. Because she was not a surgical candidate, the team pursued <strong>endoscopic treatment</strong>. The first attempt at stone removal failed, and a second attempt using <strong>lithotripsy</strong> led to an <strong>esophageal tear</strong>, requiring stent placement.

Her course was then complicated by <strong>massive vomiting, aspiration, respiratory failure requiring intubation, pleural effusions likely from an esophageal leak, renal failure, and encephalopathy</strong>. After a prolonged ICU stay, palliative care was involved, and she transitioned to comfort care and died.

Key points: gallstone disease is common and increasingly prevalent; Bouveret syndrome is rare but life-threatening; diagnosis may be delayed because symptoms are nonspecific; and treatment options include <strong>endoscopic or surgical intervention</strong>, though both can be difficult in frail, high-risk patients.

Asset Subtitle

Evan Raff

Meta Tag

Author List Elizabeth Cole, Evan Raff, Kathleen D. Aldrich, Nicholas Piazza

Category Clinical Vignettes

Concept Bouveret Syndrome

Concept Gastric Outlet Obstruction

Concept Biliary-Enteric Fistula

Concept Gallbladder Disease

Concept Endoscopic Management

Distinguished Non-Finalist

Presenter Organization University of North Carolina School of Medicine

Presenting Author Evan Raff

Track Adult

Keywords

Bouveret syndrome

gallstone ileus

gastric outlet obstruction

cholecystoenteric fistula

gallstone disease

acute cholecystitis

endoscopic treatment

lithotripsy

esophageal tear

aspiration respiratory failure

Bouveret Syndrome

Gastric Outlet Obstruction

Biliary-Enteric Fistula

Gallbladder Disease

Endoscopic Management