Systematic Reviews
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2017; 9(1): 25-36
Published online Jan 27, 2017. doi: 10.4240/wjgs.v9.i1.25
Uncommon presentation of a common disease - Bouveret's syndrome: A case report and systematic literature review
Yahya AL-Habbal, Matthew Ng, David Bird, Trevor McQuillan, Haytham AL-Khaffaf
Yahya AL-Habbal, Matthew Ng, Department of Surgery, Box Hill Hospital, Victoria 3128, Australia
David Bird, Trevor McQuillan, Department of Surgery, the Northern Hospital, Victoria 3128, Australia
Haytham AL-Khaffaf, East Lancashire Hospitals NHS Trust, the Royal Blackburn Hospital, Blackburn BB2 3HH, United Kingdom
Author contributions: All the authors contributed to the manuscript.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Data sharing statement: The dataset and statistical analysis is available from the corresponding author at
Open-Access: 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:
Correspondence to: Yahya AL-Habbal, MBChB, MRCS, FRACS, Department of Surgery, Box Hill Hospital, 8 Arnold Street, Box Hill, Victoria 3128, Australia.
Telephone: +61-409-942002 Fax: +61-394-645947
Received: September 2, 2016
Peer-review started: September 6, 2016
First decision: September 29, 2016
Revised: October 30, 2016
Accepted: December 7, 2016
Article in press: December 9, 2016
Published online: January 27, 2017

To investigate and summarise the current evidence surrounding management of Bouveret’s syndrome (BS).


A MEDLINE search was performed for the BS. The search was conducted independently by two clinicians (Yahya AL-Habbal and Matthew Ng) in April 2016. A case of BS is also described.


A total of 315 articles, published from 1967 to 2016, were found. For a clinically meaningful clinical review, articles published before 01/01/1990 and were excluded, leaving 235 unique articles to review. Twenty-seven articles were not available (neither by direct communication nor through inter-library transfer). These were also excluded. The final number of articles reviewed was 208. There were 161 case reports, 13 reviews, 23 images (radiological and clinical images), and 11 letters to editor. Female to male ratio was 1.82. Mean age was 74 years. Treatment modalities included laparotomy in the majority of cases, laparoscopic surgery, endoscopic surgery and shockwave lithotripsy.


There is limited evidence in the literature about the appropriate approach. We suggest an algorithm for management of BS.

Keywords: Bouveret’s syndrome, Biliary anomalies, Endoscopy, Digestive system, Duodenal obstruction diagnosis, Gallstones surgery, Gallstones complications, Duodenal obstruction etiology, Duodenal obstruction surgery, Intestinal fistula diagnosis, Humans

Core tip: Bouveret’s syndrome is gastric outlet obstruction secondary to an impacted gallstone in the duodenum or stomach. There is limited evidence surrounding management of this rare syndrome. Here we systematically review the published cases and recommend a treatment algorithm to clinicians facing this syndrome in future.