Bouveret syndrome occurs most commonly in elderly women. The presenting clinical situation is variable and nonspecific but often includes nausea, vomiting, and epigastric pain. A history of gallstone disease will only be present in a minority of patients 5. Exemplifying reports of non-specific symptoms and comorbidities include synchronous acute diverticulitis 6 and complicating acute pancreatitis 7, just to name a few.
Plain radiograph and CT
Rigler triad (bowel obstruction, pneumobilia, and an ectopic gallstone) is seen only in a subset of patients. In cases where the offending gallstone is identified, its size (and hence the likelihood of mechanical obstruction) may be underestimated if only the calcified portion of the stone is measured 4.
Sonography may detect the presence of a cholecystoenteric fistula, residual gallstones and gastric outlet obstruction.
Treatment and prognosis
Early diagnosis is important because mortality is high, with reported figures ranging between 12-33%.
Endoscopy is preferred as a therapeutic option because removal may be performed with mechanical, electrohydraulic, or laser lithotripsy.
Surgery often is not desirable as the patients are often poor surgical candidates secondary to concomitant illnesses and advanced age.
History and etymology
Named after Léon Bouveret, French internist (1850-1929).
- a preceding history of gallstone disease will only be present in a minority of cases 5-6
- 1. Singh AK, Shirkhoda A, Lal N et-al. Bouveret's syndrome: appearance on CT and upper gastrointestinal radiography before and after stone obturation. AJR Am J Roentgenol. 2003;181 (3): 828-30. AJR Am J Roentgenol (full text) - Pubmed citation
- 2. Léon Bouveret from whonamedit.com, the dictionary of medical eponyms. Léon Bouveret
- 3. Brennan GB, Rosenberg RD, Arora S. Bouveret syndrome. Radiographics. 24 (4): 1171-5. doi:10.1148/rg.244035222 - Pubmed citation
- 4. Gan S, Roy-choudhury S, Agrawal S et-al. More than meets the eye: subtle but important CT findings in Bouveret's syndrome. AJR Am J Roentgenol. 2008;191 (1): 182-5. doi:10.2214/AJR.07.3418 - Pubmed citation
- 5. Ayantunde AA, Agrawal A. Gallstone ileus: diagnosis and management. World J Surg. 2007;31 (6): 1292-7. doi:10.1007/s00268-007-9011-9 - Pubmed citation
- 6. Nabais C, Salústio R, Morujão I et-al. Gastric outlet obstruction in a patient with Bouveret's syndrome: a case report. BMC Res Notes. 2013;6 (1): 195. doi:10.1186/1756-0500-6-195 - Free text at pubmed - Pubmed citation
- 7. Zafar A, Ingham G, Jameel JK. "Bouveret's syndrome" presenting with acute pancreatitis a very rare and challenging variant of gallstone ileus. Int J Surg Case Rep. 2013;4 (5): 528-30. doi:10.1016/j.ijscr.2013.01.017 - Free text at pubmed - Pubmed citation