Bouveret syndrome with a synchronous jejunal gallstone in an elderly patient with high cardiac risk: A case report

Abstract

Abstract

BACKGROUNDBouveret syndrome occurs when a gallstone passes through a cholecystoenteric fistula and becomes impacted at the gastric outlet.It accounts for 0.3%-0.5% of gallstone-related complications and has a mortality rate of about 12%, primarily because it occurs in older patients with multiple comorbidities.A second stone may pass through the same fistula and lodge farther along the bowel.If overlooked, this stone can alter the operative plan. CASE SUMMARYA 72-year-old woman with hypertension, previous cerebral infarction, paroxysmal atrial fibrillation, and an unruptured intracranial aneurysm presented with gastricoutlet obstruction.Computed tomography (CT) demonstrated Rigler's triad and a synchronous jejunal stone; enteroscopy identified an impacted 5-cm duodenal gallstone.Surgery was delayed for 18 days by recurrent atrial fibrillation, cardiac treatment, cerebrovascular-risk assessment, ward transfers, and attempts to improve nutrition and inflammation, without fully restoring physiological reserve.Cholecystectomy, distal gastrectomy, duodenostomy, gastrojejunostomy, and jejunal enterolithotomy were performed.Postoperatively, purulent drainage and carbapenem-resistant Acinetobacter baumannii in abdominal drainage fluid indicated intra-abdominal infection; pulmonary infection was also possible.Noncontrast CT showed no definite anastomotic or biliary leak.Sepsis, shock, acute kidney injury, and multiple organ dysfunction followed.Active treatment was discontinued, and she was discharged in extremis on November 7, 2020; the exact time of death was not documented. CONCLUSIONCT detects synchronous ectopic stones; in high-risk patients, postoperative sepsis and limited cardiac reserve may hinder recovery.