Bouveret Syndrome: Variant of Gallstone Ileus

The patient is an 86-year-old woman with no relevant medical history who came to our emergency department complaining of abdominal pain, nausea and vomiting. On examination, she presented diffuse tenderness with no peritoneal signs. An abdominal CT scan demonstrated an image consistent with a 3.5 cm calculus in the distal segment of the horizontal portion of the duodenum and notable aerobilia (Figs. 1 and 2). Suprainfraumbilical midline laparotomy was performed, which revealed the stone distal to the angle of Treitz. Enterotomy was carried out with removal of the calculus.

Fig. 1

Fig. 2