title: Gastrointestinal bleeding and bowel obstruction as a presentation of Bouveret syndrome.
abstract: BACKGROUND
  Bouveret syndrome is a rare entity consisting of duodenal obstruction due to a gallstone from the gallbladder.
  
  
  METHODS
  We present two patients with very different ages and comorbidities whose conditions were resolved in two different ways: a 41-year-old female with right upper quadrant pain and vomiting who underwent surgical correction of obstruction and fistula, and an 81-year-old female with a high bowel obstruction, only treating the obstruction without intervention of the fistula.
  
  
  CONCLUSIONS
  It is important to include high gastrointestinal obstruction in the differential diagnosis. Diagnosis can be made either by radiological or endoscopic techniques and therapeutic options are diverse, ranging from endoscopic removal to surgery (with the resolution of obstruction and fistula in the same surgical procedure). This condition usually affects elderly patients with high comorbidities and high surgical risk; therefore, most authors recommend using the most conservative possible treatment.
authors.affiliation: Servicio de Cirugía General y del Aparato Digestivo, Hospital General Universitario "Morales Meseguer," Murcia, Spain. mmengual@msn.com
authors.forename: Mónica
authors.initials: M
authors.lastname: Mengual-Ballester
authors.forename: María Pilar
authors.initials: MP
authors.lastname: Guillén-Paredes
authors.forename: María José
authors.initials: MJ
authors.lastname: Cases-Baldó
authors.forename: María Luisa
authors.initials: ML
authors.lastname: García-García
authors.forename: José Luis
authors.initials: JL
authors.lastname: Aguayo-Albasini
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000369:Aged, 80 and over; D001658:Biliary Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D002763:Cholecystectomy; D002769:Cholelithiasis / Q000150:complications* / Q000601:surgery; D015897:Comorbidity; D004378:Duodenal Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D004380:Duodenal Obstruction / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D005260:Female; D042882:Gallstones; D015390:Gastric Bypass; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery; D012008:Recurrence; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography