Correspondence to Author: Sanjay Marwaha, Parveen Malhotra, Mahavir Jangra, Monika Dagar, Rahul Siwach, Bibin CF, Aakansha. 

Department of Surgery, Medical Gastroenterology, HealthMap Diagnostics private limited, PGIMS, Rohtak, Haryana, India

DOI: 10.52338/jjogastro.2026.5579

Abstract:

Bouveret syndrome occurs when a gallstone migrates through a cholecystoduodenal (bilioenteric) fistula and obstructs the gastric outlet or proximal duodenum. We report a patient who presented with two months history of epigastric pain and recurrent vomiting for one month. Initial imaging (USG and CECT abdomen) showed cholelithiasis with a partially distended gallbladder, grossly distended stomach, and two calcific densities in the pyloric antrum suggestive of migrated stones. Four serial upper GI endoscopies were performed: the first revealed hard extrinsic compression at D1with scope breakage; biopsies ruled out malignancy. Post-operative open subtotal cholecystectomy, duodenotomy, stone extraction, primary D1 repair, and feeding jejunostomy resolved the obstruction. Subsequent endoscopies documented progressive improvement—scope negotiation to D2 was possible by the fourth attempt, correlating with symptom resolution and tolerance of solid diet. This case highlights the value of multidisciplinary gastroenterology-surgical management in Bouveret syndrome, avoiding unnecessary relaparoscopic intervention.

Keywords: Bouveret syndrome, Gastric outlet obstruction, Gallstone ileus, Endoscopy Cholecystoduodenal fistula, Surgery.

Citation:

Dr. Parveen Malhotra, Bouveret Syndrome: A Rare PresentationManaged With Combined Surgical And Endoscopic Approach. Japanese Journal of Gastroenterology 2026.