Yang Y, Zhong DF. Cholecystogastric fistula presenting as pyloric obstruction - a Bouveret’s syndrome: A case report. World J Gastrointest Endosc 2025; 17(1): 101534 [DOI: 10.4253/wjge.v17.i1.101534]
Corresponding Author of This Article
Yi Yang, MD, Attending Doctor, Department of Gastroenterology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua People's Hospital, No. 267 Danxi East Road, Jindong District, Jinhua 321000, Zhejiang Province, China. yangyi_0325@163.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Endosc. Jan 16, 2025; 17(1): 101534 Published online Jan 16, 2025. doi: 10.4253/wjge.v17.i1.101534
Cholecystogastric fistula presenting as pyloric obstruction - a Bouveret’s syndrome: A case report
Yi Yang, Ding-Fu Zhong
Yi Yang, Ding-Fu Zhong, Department of Gastroenterology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua People's Hospital, Jinhua 321000, Zhejiang Province, China
Author contributions: Yang Y helped write and edit the manuscript and collect data; Zhong DF helped write the paper; all the authors have read and approved the content of the manuscript.
Informed consent statement: Written informed consent was obtained from the patient.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi Yang, MD, Attending Doctor, Department of Gastroenterology, Affiliated Jinhua Hospital of Wenzhou Medical University, Jinhua People's Hospital, No. 267 Danxi East Road, Jindong District, Jinhua 321000, Zhejiang Province, China. yangyi_0325@163.com
Received: September 19, 2024 Revised: December 2, 2024 Accepted: December 27, 2024 Published online: January 16, 2025 Processing time: 120 Days and 0.8 Hours
Abstract
BACKGROUND
Bouveret’s syndrome is a rare (1%-4%) form of cholelithiasis characterized by gastric outlet obstruction. It presents mainly in elderly women with nausea, vomiting, and abdominal pain. On physical examination, common findings include dehydration signs such as tachycardia, decreased urine output, abdominal discomfort, and distention. Diagnosis relies on computed tomography (CT) and magnetic resonance imaging, with Rigler's triad (pneumobilia, ectopic gallstone, gastric distension) being highly specific. This report aims to improve understanding of Bouveret’s syndrome and inform better management and treatment strategies.
CASE SUMMARY
A 60-year-old male patient presented with a three-day history of nausea, vomiting, upper abdominal pain, and loss of appetite. An upright abdominal X-ray revealed a gas shadow in the intrahepatic and extrahepatic bile ducts. Endoscopy revealed a brown and black stone measuring approximately 3030 mm in diameter in the gastric pylorus, incompletely obstructing the gastric outlet. The diagnosis of Bouveret’s syndrome was accurately confirmed via an abdominal CT scan. Endoscopic removal of the stone was successful, owing to the stone being fragmented and extracted in pieces using a crushing basket. Three weeks later, laparoscopy was attempted but failed because of severe tissue adhesions. Consequently, the procedure was converted to a laparotomy, and fistula repair and cholecystectomy were performed. He returned to the outpatient clinic for follow-up, and no further concerns were noted.
CONCLUSION
This case highlights the importance of timely diagnosis and adaptable endoscopic and surgical approaches for effectively managing Bouveret’s syndrome.
Core Tip: Bouveret’s syndrome is a rare form of cholelithiasis leading to gastric outlet obstruction. Diagnosis is confirmed through imaging, particularly abdominal computed tomography, with Rigler's triad serving as a key diagnostic indicator. Endoscopic removal of the gallstone is the first-line treatment, but surgery is required if endoscopic methods fail, especially in cases with severe adhesions. In this case, a 60-year-old male had successful endoscopic stone removal. Laparotomy was later performed for fistula repair and cholecystectomy after laparoscopy failed. This case highlights the importance of early diagnosis and flexible treatment, combining endoscopy and surgery for the best outcomes.
