Bouveret’s Syndrome- An Uncommon Variant of Gallstone Ileus: Case Series and Review of Literature

Abstract

Bouveret’s syndrome is a rare form of gallstone ileus. It refers to gastric outlet or small bowel obstruction caused by the formation of a biliary enteric fistula with subsequent migration and impaction of a large gallstone into stomach or small intestine. Its diagnosis is often delayed or overlooked. Diagnosis is based on the clinical manifestations, presence of pneumobilia, visualisation of stone and demonstration of small bowel obstruction on imaging. Enterotomy or gastrotomy with or without cholecystectomy and fistula repair is the most common surgical therapy. The aim of this case series was to analyse the presentation of Bouveret’s syndrome and strategise the optimum surgical approach based on the available literature and authors experience. Authors hereby report three cases of Bouveret’s syndrome encountered within last two years with clinical presentation, surgical approaches and operative findings. Computed Tomography (CT) scan is most commonly used to diagnose this rare entity. Early detection and optimum timing of surgery plays crucial role in outcome. It has high success rate, with acceptable surgical morbidity and mortality. Heightened awareness of this syndrome may lead to decreased morbidity and mortality.

Keywords

• biliary enteric fistula
• enterotomy
• gastrotomy
• pneumobilia
• small bowel obstruction