Bouveret Syndrome (Bilioduodenal Fistula)

Bouveret syndrome is a rare complication of gallstone disease (0.3% to 0.5%), characterized by gastric outlet obstruction (GOO). This infrequent form of gallstone ileus arises from the impaction of a large stone in the proximal duodenum or pylorus secondary to a spontaneous fistula between the gallbladder and the duodenum or stomach (see Gallstone Ileus in the Jejunum). Due to its rare nature, only 315 cases have been reported in 50 years between 1967 and 2016. It was first described preoperatively by French surgeon M. Beassier in 1770. However, subsequently, L. Bouveret, a French physician, published 2 comprehensive case reports 1896 of this condition, and it was named after him. Bouveret syndrome has a high mortality, estimated at 12 to 30%, because an elderly age group is usually afflicted, and delay of diagnosis owing to its non-specific presentation and the complexity of the disease. Also, because the disease is rare, there is no agreed guidance for diagnostic workup and management, including endoscopic, laparoscopic, and open surgery.