The Bouveret’s Syndrome: A Case Report of a Rolling Gallstone from the Gallbladder to the Duodenum

Abstract

We report a case of a 92-year-old man complaining of epigastric pain, which an US first and a CT scan later revealed to be related to a large gallstone causing cholecystitis. After the patient had refused surgical treatment for this condition, he was again referred to our Emergency Department presenting with a clinical picture of gastric obstruction. A new CT scan showed the classic Rigler's triad, characterized by pneumobilia, gastric distension and gallstone in the duodenal lumen, which was pathognomonic for a rare form of gallstone ileus named Bouveret's syndrome. The cause of this event was found out to be the chronic inflammation of gallbladder wall and its consequent erosion, which led to formation of gallbladder-duodenum fistula and the movement of the gallstone from the gallbladder to the duodenum where it impacted. This is a high morbidity and mortality condition, which affects mostly elderly people and needs early diagnosis and surgical treatment.