OBSTRUÇÃO GÁSTRICA POR SÍNDROME DE BOUVERET SIMULANDO MALIGNIDADE: RELATO DE CASO E REVISÃO DA LITERATURA

Bouveret’s syndrome is a rare complication of cholelithiasis, caused by gallstone impaction in the pylorus or proximal duodenum through a bilioenteric fistula, accounting for less than 0.5% of gallstone disease cases. Clinical presentation is usually nonspecific, which hinders early diagnosis and contributes to high mortality rates. We report the case of a 40-year-old male patient admitted with epigastric pain, progressive dysphagia, significant weight loss, and recurrent vomiting, initially suspected of having gastric malignancy. Endoscopic and imaging studies suggested an infiltrative stenosing lesion in the pyloric antrum. Subtotal gastrectomy with lymphadenectomy and en bloc cholecystectomy was performed. Histopathological analysis, complemented by immunohistochemistry, excluded malignancy and confirmed a chronic ulcerative inflammatory process with bilioenteric fistulization, consistent with Bouveret’s syndrome. This case underlines the importance of considering this rare entity in the differential diagnosis of gastric outlet obstruction and reinforces the need for individualized therapeutic approaches.