Bouveret syndrome in 2 parts: endoscopic removal of residual cholelithiasis with closure of cholecystoduodenal fistula after initial surgical management

A 69-year-old woman with no medical history presented to the emergency department with 1 week of nausea, vomiting, and anorexia. A CT examination of the abdomen and pelvis demonstrated an obstructing 3.3-cm jejunal gallstone and a separate fistulous connection between the gallbladder and the first portion of the duodenum (Figs. 1 and 2). Because of the patient’s urgent clinical presentation with severe abdominal pain, hypotension, and electrolyte derangement, emergent exploratory laparotomy and jejunal gallstone removal were performed; the GI department was not initially consulted.