# Bouveret Syndrome Presenting as Duodenal Bulb Stenosis and Gastric Outlet Obstruction: A Case Report

## TL;DR

A rare case of Bouveret syndrome caused gastric outlet obstruction in a 61-year-old man, diagnosed through endoscopy after initial imaging failed to identify the issue.

## Contribution

This case report adds a new clinical example of Bouveret syndrome presenting with duodenal bulb stenosis and highlights diagnostic challenges.

## Key findings

- Initial imaging failed to identify the obstructing gallstones in the duodenum.
- Endoscopy revealed a cholecystoduodenal fistula filled with gallstones.
- Spontaneous evacuation of gallstones resolved symptoms, emphasizing the need for timely endoscopic evaluation.

## Abstract

Bouveret syndrome, or gallstone obstruction of the duodenum, is a rare cause of gastric outlet obstruction, where gallstones migrate through a bilioenteric fistula and obstruct the pylorus or duodenum. Here, we present a case of a 61-year-old man who presented with intractable nausea and vomiting. Initial imaging, such as computed tomography of the abdomen and pelvis, showed gastric distention without an obvious obstructing lesion, and a subsequent upper endoscopy revealed a cholecystoduodenal fistula filled with gallstones, posterior to a stenotic region in the duodenal bulb. The calculi were spontaneously evacuated, the patient’s symptoms resolved, and the patient was referred for surgical management. This case highlights the diagnostic challenges of Bouveret syndrome, particularly in the setting of atypical imaging, and emphasizes the importance of timely endoscopic assessment in uncovering rare etiologies of gastric outlet obstruction.