Bouveret's syndrome

Bouveret's syndrome is a gastric outlet obstruction produced by a gallstone impacted in the distal stomach or proximal duodenum.

Demographics
Occurs most commonly in elderly women with a mean age of 69 years.

Symptoms & Signs
The presenting clinical situation is variable and nonspecific but often includes nausea, vomiting, and epigastric pain.

Early diagnosis is important because mortality is historically high at 33%, although it has decreased to 12% in recent years.

Diagnosis

 * Rigler's triad is characteristic findings of imaging studies:


 * bowel obstruction
 * pneumobilia
 * ectopic gallstone

Treatment
Endoscopy is preferred as a therapeutic option because removal may be performed with mechanical, electrohydraulic, or laser lithotripsy.

Surgery often is not desirable as the patients are often poor surgical candidates secondary to concomitant illnesses and advanced age.