A 75-year-old woman on long-term NSAIDs presents with colicky abdominal pain and bilious vomiting. AXR shows dilated small bowel loops with a ground glass opacity in the right iliac fossa. CT scan confirms Bouveret syndrome. Which of the following best describes this condition?

• A Gallstone ileus with obstruction at the ileocaecal valve after stone migration through a cholecystoduodenal fistula
• B Acute calculous cholecystitis causing reactive ileus and pseudo-obstruction
• C Adhesive small bowel obstruction at the site of a previous cholecystectomy
• D Gallstone causing gastric outlet obstruction by impaction in the duodenum via a cholecystoduodenal fistula ✓

Explanation

Bouveret syndrome is a rare form of gallstone ileus in which a large gallstone (typically >2.5 cm) passes through a cholecystoduodenal fistula and impacts in the duodenal bulb or duodenum, causing gastric outlet obstruction rather than the classic ileocaecal ileus. It presents with intractable vomiting and upper abdominal pain. CT demonstrates the stone, pneumobilia (air in biliary tree), and duodenal obstruction. Classic gallstone ileus (obstruction at ileocaecal valve) shows Rigler's triad: small bowel obstruction, pneumobilia, and ectopic gallstone.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.