title: [Bouveret's syndrome: A rare presentation of gallstone ileus].
abstract: BACKGROUND
  Bouveret's syndrome is defined as gastric outlet obstruction caused by duodenal impaction of a gallstone which passes into the duodenal bulb through a cholecystoduodenal fistula.
  
  
  METHODS
  We reported the case of a 46-year-old woman who presented intermittent epigastric pain, nausea, vomiting, and weight loss of 2-months duration. The patient admitted alcohol and methamphetamine abuse. She had not fever, dehydration or jaundice. Amylase, electrolytes, enzymes, and creatinine level were within normal limits. Seven months previously she was seen in the emergency department for acute cholecystitis. In that occasion, an abdominal ultrasound was reported with cholelithiasis without dilatation of the intra/extra-hepatic bile duct. Abdominal plain radiographs showed no relevant findings. A laparoscopic surgery was performed. During the procedure a sub-hepatic plastron with firm adhesions was found. The gallbladder was found attached to the duodenal bulb and an impacted calculus in the duodenum. The procedure was converted to surgery. Surgeon decided to perform a Bilroth 1 as the best choice. Seven days later, she was discharged.
  
  
  CONCLUSIONS
  The clinical manifestations of the Bouveret's syndrome are nonspecific. Preoperative diagnosis is a challenge for clinicians because of the rarity of this condition. Treatment must be individualized.
authors.affiliation: Hospital General de Mexicali, Instituto de Servicios de Salud Pública del Estado de Baja California, Mexicali, Baja California, México. dr_omr_2012@yahoo.com.
authors.forename: Luis
authors.initials: L
authors.lastname: Franco-Avilés
authors.forename: Héctor Tonalli
authors.initials: HT
authors.lastname: Arce-Guridi
authors.forename: Ulises
authors.initials: U
authors.lastname: Mercado
mesh_terms: D004380:Duodenal Obstruction / Q000175:diagnosis* / Q000209:etiology; D005260:Female; D042882:Gallstones / Q000150:complications*; D017219:Gastric Outlet Obstruction / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D045823:Ileus / Q000175:diagnosis* / Q000209:etiology; D008875:Middle Aged; D013577:Syndrome
keywords: Bile duct diseases; Gallbladder; Gallstones