Bouveret syndrome is one of the complications of gallstone disease possibly fatal, which is secondary to the presence of a large stone obliterating the lumen of the duodenum or stomach because of the formation of a cholecystoduodenal fistula. The gallstone reaches the duodenum through a bilioenteric fistula as a consequence of chronic inflammation and adherence between the gallbladder and the duodenum which increase the intraluminal pressure and leads to secondary wall ischemia and wall perforation with gallstone passage into the duodenum. Bouverets syndromes prevalence is highest among elderly women. Despite the rarity of Bouverets syndrome, it can cause notable morbidity and mortality rates. We report a rare case of Bouverets syndrome revealed by an unusual clinical picture of upper gastrointestinal bleeding in a 64-year-old patient. He had been admitted for significant gastrointestinal bleeding due to a probable antral stromal tumour. Endoscopic investigations had been inconclusive. An abdominal CT scan revealed a 72 x 43 mm mass in the second part of the duodenum in contact with the posterior wall of the stomach. Surgical exploration revealed a cholecystoduodenal fistula through which a large number of clots were passing, along with a huge stone measuring more than 7 cm inside the duodenum, extending up to the gastric antrum. After antroduodenotomy, we discovered almost complete erosion of D1 by the stone, which explained the haemorrhages. An antroduodenectomy (D1) was performed due to the parietal destruction of D1 and the very high risk of haemorrhage. The outcome was favourable. The medical history revealed a history of a large untreated gallstone.
Bidzo et al. (Thu,) studied this question.