A Case of Bouveret's Syndrome with Gallstone moved back to the Stomach

Takashi Murakami, Ryutaro Mori, Mari Sasaki, Motohiko Tokuhisa, Seiji Hasegawa, Koichiro Misuta, Kazuya Eguchi and Akira Nakano

Department of Surgery, Fujisawa Municipal Hospital

An 81-year-old man was admitted to our hospital for calculus cholecystitis; he showed improvement after conservative treatment. However, after 1 month, he presented with sudden episodes of vomiting with loss of appetite. Abdominal computed tomography revealed a gallstone that was 8 cm in diameter; the calculus had displaced from the gallbladder to the duodenal bulb through a fistula. Upper gastrointestinal series revealed a cholecystoduodenal fistula. Bouveret's syndrome was diagnosed. The symptoms improved after the gallstone had displaced to the stomach. We attempted to crush the gallstone endoscopically, but the attempt was unsuccessful. Therefore, operation was performed. We closed the cholecystoduodenal fistula, extracted the gallstone present in the stomach, and performed cholecystectomy and gastrojejunostomy because of duodenal stenosis. This is the first report of a patient with Bouveret's syndrome who showed improvement in symptoms after an impacted gallstone had displaced from the duodenal bulb to the stomach.

Key words
Bouveret's syndrome, gallstone ileus, cholecystoduodenal fistula

Reprint requests
Ryutaro Mori Department of Surgery, Fujisawa Municipal Hospital
2-6-1 Fujisawa, Fujisawa, 251-8550 JAPAN

Accepted
January 27, 2010

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