Delayed Diagnosis of Gastric Outlet Obstruction From Bouveret Syndrome in a Young Woman

Zachary Smith, DO; Jodie Totten, MD; Adrienne Hughes, MD; Jared Strote, MD

Disclosures

Western J Emerg Med. 2015;16(1):151-153. 

In This Article

Abstract and Introduction

Abstract

Bouveret syndrome is a rare presentation of gastric outlet obstruction caused by a gallstone in the proximal duodenum via a bilioenteric fistula. This is an infrequent although clinically significant cause of abdominal pain, almost exclusively in the elderly. The clinical presentation is similar to that of a small bowel obstruction with abdominal pain, nausea and vomiting. Surgery or endoscopy is often required for definitive diagnosis and therapy. We describe the case of a young woman with this condition who had a delayed diagnosis in part because of her age and the rarity of the condition.

Introduction

Bouveret syndrome is a rare presentation of gastric outlet obstruction caused by a gallstone in the proximal duodenum via a bilioenteric fistula. Gallstone ileus is uncommon itself, accounting for only 1–4% of intestinal obstructions and Bouveret syndrome is seen in only 1–3% of gallstone ileus cases. Presentations of Bouveret syndrome are at risk of being missed, as symptoms are frequently non-specific and presentations are often benign. The disease is almost exclusively one of the elderly, increasing the likelihood of missed diagnosis when it occurs in younger patients.[1] We describe the case of a young woman with this condition who had a delayed diagnosis in part because of her age and rarity of the condition.

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