title: Gastric outlet obstruction in a patient with Bouveret's syndrome: a case report.
abstract: BACKGROUND
  Gallstone ileus accounts for 1% to 4% of cases of mechanical bowel obstruction, but may be responsible for up to 25% of cases in older age groups. In non-iatrogenic cases, gallstone migration occurs after formation of a biliary-enteric fistula. In fewer than 10% of patients with gallstone ileus, the impacted gallstones are located in the pylorus or duodenum, resulting in gastric outlet obstruction, known as Bouveret's syndrome.
  
  
  METHODS
  We report an 86-year-old female who was admitted to hospital with a 10-day history of persistent vomiting and prostration. She was in hypovolemic shock at the time of arrival in the emergency department. Investigations revealed a gallstone in the duodenal bulb and a cholecystoduodenal fistula. She underwent surgical gastrolithotomy. Unfortunately, she died of aspiration pneumonia on the fourth postoperative day.
  
  
  CONCLUSIONS
  This case shows the importance of considering Bouveret's syndrome in the differential diagnosis of gastric outlet obstruction, especially in the elderly, even in patients with no previous history of gallbladder disease.
authors.affiliation: Department of Surgery, Hospital de São José, Centro Hospitalar de Lisboa Central, Serviço de Cirurgia 1, Rua José António Serrano, 1150-199, Lisboa, Portugal. celso.nabais@gmail.com
authors.forename: Celso
authors.initials: C
authors.lastname: Nabais
authors.forename: Raquel
authors.initials: R
authors.lastname: Salústio
authors.forename: Inês
authors.initials: I
authors.lastname: Morujão
authors.forename: Francisco V
authors.initials: FV
authors.lastname: Sousa
authors.forename: Eusébio
authors.initials: E
authors.lastname: Porto
authors.forename: Carlos
authors.initials: C
authors.lastname: Cardoso
authors.forename: Caldeira
authors.initials: C
authors.lastname: Fradique
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017219:Gastric Outlet Obstruction / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D007412:Intestinal Fistula / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D014057:Tomography, X-Ray Computed