Case report: open surgical management of Bouveret syndrome

Bouveret syndrome is a rare type of gallstone ileus, where a gallstone obstructs the duodenum due to a cholecystoduodenal fistula, accounting for 1-3% of cases, predominantly in women. The presentation of Bouveret syndrome is often nonspecific, including acute cholangitis, nausea, vomiting, and abdominal pain, with significant morbidity and mortality risks. We report a 73-year-old man with complicated gallstone ileus, presenting with abdominal pain, nausea, and vomiting. Imaging revealed a 3-cm stone located in the proximal duodenum and was suspected to be associated with a choledochoenteric fistula. The procedure started laparoscopically but was converted to open surgery, successfully removing the stone. Postoperatively, the patient required bowel rest and total parenteral nutrition. He was discharged with a gastrostomy tube and a Jackson-Pratt drain for outpatient follow-up. A standardized surgical protocol that includes both endoscopic and open techniques should be investigated for effective management of Bouveret syndrome.