Bouveret’s syndrome: A challenging case of gastric outlet obstruction.

  • Marrium Gul CMH Multan.
  • Irfan Qadir Combined Military Hospital Multan.
  • Muhammad Qasim Butt Combined Military Hospital, Multan.
Keywords: Bouveret’s Syndrome, Cholelithiasis, Gastric Outlet Obstruction, Gall Bladder, Pakistan


Bouveret’s syndrome causes gastric outlet obstruction when a gallstone is impacted in the duodenum or stomach via a bilioenteric fistula. We present case of a 40-year-old female presented with epigastric pain and intractable vomiting for 2 days. Her physical examination and laboratory workup including blood analysis, amylase test and lipase test were normal. Plain abdominal X-ray did not show any signs of small bowel obstruction. A nasogastric tube was placed and drained 2.5 L of gastric contents immediately. Esophagogastroduodenoscopy showed a dilated stomach with excessive secretions and a large blackish-brown hard stone in the duodenal bulb. After failed attempt at endoscopic extraction, patient underwent laparotomy and removal of stone via duodenal incision. Subsequently, the patient exhibited a good postoperative recovery. The condition of the patient has remained stable after being followed up for one year.

Author Biographies

Marrium Gul, CMH Multan.


House Officer Surgery

Irfan Qadir, Combined Military Hospital Multan.


Resident General Surgery

Muhammad Qasim Butt, Combined Military Hospital, Multan.

FCPS (General Surgery)

Assistant Professor General Surgery

Classified Surgical Specialist General Surgery