Bouveret's Syndrome: Literature Review

Abstract

It was in 1896 that Bouveret’s syndrome acquired its name after the French physician Leon Bouveret, who published two case reports in Revue de Medecin. Bouveret’s syndrome describes gastric outlet obstruction secondary to an impacted gallstone. The gallstone reaches the small bowel through a bilioenteric fistula as a consequence of chronic inflammation and adherence between the biliary system and the bowels which increase the intraluminal pressure and leads to secondary wall ischemia and wall perforation with gallstone passage into the bowel. Bouveret’s syndrome’s prevalence is highest among elderly women. Despite the rarity of Bouveret’s syndrome, it can cause notable morbidity and mortality rates. We underwent a review of literature about Bouveret syndrome to increase awareness of its occurrence and potentially life-threatening complications.

Spontaneous cholecystoduodenal fistula - spectrum of complications

“…One of the complications of the cholecystoduodenal fistula was presented in our second case -Bouveret syndrome, which implies proximal duodenal or distal stomach obstruction by biliary calculus. It is a rare syndrome that affects elderly women with previous history of biliary calculosis [6,14,15].…”

“…A review of 1,001 cases concluded that simple enterolithotomy was both safe and effective in managing patients with gallstone ileus [23]. It is still a matter of debate whether cholecystectomy and repair of the fistula should be performed, due to spontaneous closure of fistulas in some cases [6,15].…”

“…The pathognomonic triad (Rigler triad) of pneumobilia, small-bowel distention, and ectopic gallstones on conventional abdominal radiographs is seen in 30-35% of all cases with gallstone ileus [1][2][3][4][5]. Duodenal obstruction caused by an ectopic gallstone happens in only 1-3% of the patients and is known as the Bouveret syndrome [1,6,7].The rarest complication is a floating non-obstructing gallstone trapped in the stomach, which can also lead to gastric outlet, persistent emesis, and esophageal rupture (Boerhaave syndrome), as reported in the study by Modi et al [8].…”

Management of Bouveret's syndrome

“…Regardless of the surgical approach used, examining the remaining small intestine is paramount for excluding the presence of any intestinal gallstones that could result in a future obstruction. 8 Cholecystectomy and fistula repair are recommended to reduce the risk of future recurrence, gallstone pancreatitis, gallstone ileus, and gallbladder cancer, 4 and they can be performed in one or two stages. Fistula repair options include primary closure, an omental patch, jejunoduodenostomy, and in rare instances, a Whipple pancreaticoduodenectomy.…”

“…2,7 Moreover, 42% of patients who required surgery had failed at least one endoscopic trial for removing the stones. 2,8 Nevertheless, surgical treatment carries an increased risk of morbidity and mortality. 1 Surgery should be considered in hemodynamically unstable patients, patients who fail endoscopic treatment trials, and those with concurrent distal gallstone ileus.…”