Bouveret Syndrome: Diagnostic and Therapeutic Challenges – A Retrospective Case Series and Literature Review

Emilia Grossu; Catalin Cosma; Marian Botoncea; Vlad Olimpiu Butiurca; Calin Molnar

doi:10.33695/rojes.v7i1.133

Emilia Grossu George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures
Catalin Cosma George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures,SCJU Tg.Mures Chirurgie 1 https://orcid.org/0009-0008-2109-7557
Marian Botoncea George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures,SCJU Tg.Mures Chirurgie 1
Vlad Olimpiu Butiurca George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures
Calin Molnar

DOI: https://doi.org/10.33695/rojes.v7i1.133

Keywords: Bouveret syndrome; gastric outlet obstruction; gallstone ileus; cholecystoenteric fistula; surgical management

Abstract

Introduction: Bouveret syndrome is a rare variant of gallstone ileus characterized by gastric outlet obstruction secondary to the migration of a gallstone through a cholecystoenteric fistula. Due to its low incidence and nonspecific clinical presentation, diagnosis is frequently delayed, contributing to increased morbidity and mortality, particularly in elderly patients with significant comorbidities.
Material & Method: A retrospective observational study was conducted including all patients diagnosed with Bouveret syndrome between January 2018 and December 2024 at the Emergency County Hospital Târgu Mureș, Department of General Surgery I. Diagnosis was established using imaging, endoscopy, or intraoperative findings. Clinical, laboratory, imaging, and therapeutic data were collected from medical records. The primary endpoint was therapeutic success, while secondary outcomes included postoperative morbidity, length of hospital stay, intensive care unit admission, and in-hospital and 30-day mortality. Statistical analysis was descriptive, using medians (IQR) and proportions. In parallel, a narrative literature review was performed using PubMed, Web of Science, and Scopus databases to identify relevant studies addressing the diagnosis and management of Bouveret syndrome.
Results: Seven patients were identified, with a median age of 73 years and a predominance of female patients (71.4%). All patients presented with symptoms of gastric outlet obstruction. Computed tomography was performed in all cases and identified Rigler’s triad in 71.4% of patients, while a cholecystoenteric fistula was detected in 85.7%. Endoscopic treatment was initially attempted in 71.4% of patients but achieved a low success rate (20%). Surgical intervention was required in 85.7% of cases, with enterolithotomy being the most frequently performed procedure. Postoperative outcomes reflected the high-risk profile of the cohort, with frequent ICU admissions, major complications in over half of the patients, and a 30-day mortality rate of 42.9%. The literature review confirmed similar findings, highlighting the predominance of elderly patients, the diagnostic role of computed tomography, the limited success of endoscopic therapy, and the frequent need for surgical management.
Conclusion: Bouveret syndrome is a rare but severe cause of gastric outlet obstruction in elderly patients. Computed tomography plays a pivotal role in diagnosis, while surgical intervention remains the definitive treatment in most cases. The integration of institutional experience with current literature underscores the importance of early recognition and individualized management strategies to improve clinical outcomes.

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