14 A Rare Case of Bouveret Syndrome Following Subtotal Cholecystectomy

Abstract Background Bouveret syndrome is an uncommon cause of gastric outlet obstruction wherein a large gallstone becomes lodged in the proximal duodenum or pylorus through a cholecystoduodenal fistula. Its incidence is extremely rare in patients who underwent prior subtotal cholecystectomy. Case presentation We report a case of a 54-year-old Caucasian lady presenting with progressive vomiting, intolerance of solids and liquids and abdominal distension 6 years after a subtotal cholecystectomy. Cross-sectional imaging revealed gastric dilatation, a gallstone in residual gallbladder tissue and proximal duodenal obstruction. As conservative as well as endoscopic attempts failed to resolve the resultant gastric outlet obstruction, she was referred to the local hepato-biliary center who managed her with a one stage completion cholecystectomy, full closure of the cholecystoduodenal fistula with a falciform patch and gastrojejunostomy. She had an uneventful recovery and remained symptom-free in 2 months follow-up. Discussion This case highlights the need to consider Bouveret Syndrome as differential diagnosis in patients who presents with gastric outlet obstruction after subtotal cholecystectomy. Delayed complications from remnant gallbladder tissue should remain within the differential and cross-sectional imaging is an important diagnostic tool. Surgical intervention, which addresses the obstructing stone as well as the fistula, can lead to more favorable outcomes when conservative and endoscopic measures fail. Conclusions Clinicians should consider Bouveret syndrome as a potential rare long-term complication after a subtotal cholecystectomy. Effective management of this unique patient population requires early diagnosis and a multidisciplinary approach.