Bouveret's Syndrome

Bouveret syndrome describes gastric outlet obstruction secondary to an impacted gallstone that has entered the small intestine through a bilioenteric fistula. Fistula formation is a consequence of chronic inflammation and adhesion between the biliary system and the intestine, increasing the intraluminal pressure and causing wall ischemia and perforation of the wall with the passage of gallstones into the intestine. The prevalence of Bouveret syndrome is highest among older women, with a median age at presentation of 74 years. Despite the rarity of Bouveret syndrome, it can cause significant morbidity and mortality. Through the fistula, gallstones can enter the intestinal system and cause obstruction of the gastric outlet. Gallstone ileus is extremely rare, complicating only 0.3%¿0.5% of patients with cholelithiasis. Bouveret syndrome accounts for ~ 1%-3% of cases of gallstone ileus.