Bouveret syndrome

Case contributed by Dr Franco A. Scola

Presentation

Nausea and vomiting.

Patient Data

Age: 75 years
Gender: Male
CT

An important gastric distension is identified in the pyloric region.

No small bowel or colonic distension.

The gallbladder contains gas and is in intimate contact with the pylorus and duodenum.

No biliary tree dilatation.

Hypodense nodular formations are seen in both renal parenchymas.

Arterial calcifications.

No free fluid or pneumoperitoneum.

MRI

A gastric tube was placed and and MRCP performed next day, revealing:

Moderate gastric distension.

The gallbladder contains multiple small calculi at the fundus and a larger calculus near the infundibulum.

Inside the pylorus, there is an ovoid low T1WI and T2WI signal intensity formation, very similar to the gallstones. There is also a continuous trait through the gallbladder to the pylorus ovoid formation, best visualized on coronal T2WI.

Simple cysts in both kidneys.

Case Discussion

A patient presenting with an acute gastric outlet obstruction and gas in the gallbladder should incite the possibility of a gallstone migration to the pylorus/duodenum through a fistulous tract.

The patient went to surgery, which confirmed the diagnosis of Bouveret syndrome.

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Case information

rID: 61017
Published: 13th Jun 2018
Last edited: 16th Jul 2018
Inclusion in quiz mode: Included

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