A rarer cause of Bouveret syndrome-A case report

Introduction and importance: Bouveret syndrome is a rare type of gallstone ileus causing gastric outlet obstruction with high morbidity and mortality risk, and hence important to have a high degree of clinical suspicion on presentation for prompt diagnosis and management. Case presentation: We present a case of an elderly woman with abdominal pain, haematemesis, and an unre-markable radiograph whose initial emergent endoscopy showed a gastric obstruction and a duodenal divertic-ulum with a non-bleeding broad based duodenal ulcer. Subsequent computerised tomographic (CT) scan revealed a cholecystoduodenal fistula and gastric outlet obstruction secondary to a 5 cm stone in the duode-nojejunal (DJ) flexure. A repeat endoscopy was attempted for endoscopic removal prior to proceeding to open enterolithotomy. Clinical discussion: This case highlights the challenges in diagnosis and discusses the latest literature on multi-modal management consisting of endoscopy and surgery. Conclusion: The location of the obstructing stone at the duodenojejunal flexure is extremely rare and therefore will add to world literature on Bouveret syndrome.