Secondary Gallstone Ileus Due to Bouveret Syndrome: Case Report

Abstract

Bouveret syndrome is an uncommon variant of gallstone ileus, in which a gallstone migrates through a cholecystoduodenal fistula and lodges in the duodenal bulb or stomach, causing a high gastrointestinal obstruction. It accounts for less than 3% of all gallstone ileus cases and typically occurs in elderly patients with multiple comorbidities, being even rarer in young patients without significant clinical history. Symptoms include persistent nausea, vomiting, abdominal pain, and oral intolerance, which can mimic other acute abdomen presentations and delay diagnosis. We present the case of a 45-year-old female patient who arrived at the emergency department with a six-day clinical picture characterized by abdominal distension, constipation, postprandial gastrobiliary vomiting, severe generalized abdominal pain (VAS 10/10), and oral intolerance. Physical examination revealed signs of peritoneal irritation, and imaging studies showed pneumobilia, air-fluid levels, and a stone in the distal ileum. Abdominal computed tomography confirmed the presence of gallstones, pneumobilia, a cholecystoduodenal fistula, and an obstructive stone. An urgent exploratory laparotomy was performed with extraction of the stone via enterolithotomy, primary closure of the enterotomy, fistula repair with a Graham patch, and open cholecystectomy of the remaining gallbladder portion. Postoperative evolution was satisfactory. This case highlights an atypical presentation of Bouveret syndrome in a young patient, as well as the importance of timely diagnosis and comprehensive surgical intervention in managing this rare condition.