SHM Converge Scientific Abstract ePoster Gallery-Beyond the Bezoar: A Rare Case of Bouveret Syndrome Leading to Duodenal Adenocarcinoma

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This case describes a rare and clinically important association between Bouveret syndrome and duodenal adenocarcinoma. Bouveret syndrome is an uncommon form of gallstone ileus caused by a cholecystoduodenal fistula, which allows a gallstone to migrate into the proximal duodenum and produce gastric outlet obstruction. Although bezoars and other obstructing masses are more commonly associated with altered GI anatomy or motility, this patient’s presentation ultimately revealed a malignant cause.<br /><br />A 73-year-old man presented with 2 days of abdominal pain, nausea, and vomiting. CT imaging showed irregularity of the duodenal bulb, prompting gastroenterology evaluation for gastric outlet obstruction. He underwent EGD, diagnostic laparotomy, and small bowel resection. Initial pathology identified invasive adenocarcinoma of the duodenal bulb. After surgery, his abdominal symptoms improved and he began passing flatus. Repeat EGD showed persistent duodenal ulceration and a duodenal mass with villous architecture and dysplastic glandular epithelium. Endoscopic ultrasound confirmed a malignant mass on the posterior duodenal wall. ERCP was attempted but could not be completed because the mass could not be traversed. The patient then underwent surgical resection with lymph node biopsy, and final pathology confirmed invasive adenocarcinoma of the duodenal bulb.<br /><br />The case emphasizes that while endoscopic therapy is usually first-line for Bouveret syndrome, persistent obstruction and chronic inflammation may warrant surgical management. It also highlights the possibility that long-standing biliary-enteric fistulas and repeated mucosal injury may contribute to malignant transformation.

Asset Subtitle

Adwoa Agyei

Meta Tag

Author List Adwoa Agyei, Brooke Fitch, Praneeth Kambhampati, Suganya ArunachalamKarikalan

Category Clinical Vignettes

Concept Bezoar

Concept Bouveret Syndrome

Concept Endoscopic Therapy

Concept Cholecystoduodenal Fistula

Concept Gastric Outlet Obstruction

Distinguished Non-Finalist

Presenter Organization Christus Good Shepherd

Presenting Author Adwoa Agyei

Track Adult

Keywords

Bouveret syndrome

duodenal adenocarcinoma

gallstone ileus

cholecystoduodenal fistula

gastric outlet obstruction

duodenal bulb

endoscopic ultrasound

ERCP

surgical resection

malignant transformation

Bezoar

Bouveret Syndrome

Endoscopic Therapy

Cholecystoduodenal Fistula

Gastric Outlet Obstruction