title: A rare presentation of gastric outlet obstruction (GOO) - The Bouveret's syndrome.
abstract: BACKGROUND
  Bouveret's Syndrome is a rare cause of Gastric outlet obstruction (GOO) caused by a gall stone which has migrated into the duodenal bulb from a bilioduodenal fistula. It is an uncommon condition and only a few cases have been reported in the medical literature till to date.
  
  
  METHODS
  We report a case of a 45 year old woman who presented to us with recurrent pain in the upper abdomen for the last 8 years, and that progressed to develop symptoms of gastric outlet obstruction. An upper gastrointestinal endoscopy revealed duodenal ulceration with a stony hard lesion in the first part of duodenum. An contrast enhanced computed tomography (CECT) scan of the abdomen performed later confirmed the presence of cholecystoduodenal fistula and a gall-stone in proximal jejunum.
  
  
  CONCLUSIONS
  Bouveret's syndrome is a case of gastric outlet obstruction caused by the impaction of a large gall stone in the duodenum as a result of a cholecystoduodenal fistula. It constitutes 1-3% of cases of gall stone ileus which in turn complicates only 0.3-4% cases of cholelithisasis. Bouveret's syndrome is managed surgically.
  
  
  CONCLUSIONS
  Bouveret's syndrome being an uncommon condition may pose a difficulty in diagnosis and dilemma in managing such patients. An awareness is hence essential.
authors.affiliation: Dept. of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India.
authors.forename: Dheer Singh
authors.initials: DS
authors.lastname: Kalwaniya
authors.affiliation: Dept. of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India.
authors.forename: S V
authors.initials: SV
authors.lastname: Arya
authors.affiliation: Dept. of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India.
authors.forename: Soumya
authors.initials: S
authors.lastname: Guha
authors.affiliation: Dept. of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India.
authors.forename: Manigandan
authors.initials: M
authors.lastname: Kuppuswamy
authors.affiliation: Dept. of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India.
authors.forename: Jasneet G
authors.initials: JG
authors.lastname: Chaggar
authors.affiliation: Dept. of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India.
authors.forename: Lalmalsamwe
authors.initials: L
authors.lastname: Ralte
authors.affiliation: Dept. of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India.
authors.forename: Rajkumar
authors.initials: R
authors.lastname: Chejera
authors.affiliation: Dept. of General Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India.
authors.forename: Ashok
authors.initials: A
authors.lastname: Sharma
keywords: Bouveret's syndrome; CECT, contrast enhanced computed tomography; Cholecystoduodenal fistula; GOO, gastric outlet obstruction; Gastric outlet obstruction; PEA, pulseless electrical activity
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