Bouveret syndrome associated with acute gangrenous cholecystitis.

An 89-year-old patient was hospitalized with signs of acute lithiasic cholecystitis and gastric emptying failure. The decision for surgery was taken and a subhepatic block was evidenced, caused by a perforated gangrenous cholecystitis with pericholecystic abscess, a cholecysto-antroduodenal fistula with two gallstones, 9/5 and 4/3 cm in size, impacted in the duodenum. It was necessary to perform an Y-en-Roux antroduodenojejunal anastomosis because an antroduodenal parietal defect resulted after the removal of the gangrenous gallbladder. The immediate and long term postoperative evolution in terms of anastomosis functionality was good.