A Case Of ‘The Rolling Gallstones’

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Introduction

Bouveret syndrome presents as a gastric outlet obstruction caused by a single gallstone within the pyloric channel or duodenum. The stone usually travels from biliary tree via a chole-pyloric fistula. We present an 86 year old male admitted with vomiting. Initial abdominal x-ray showed radio-opaque rounded lesion distal to gastric bubble. CT imaging demonstrated gastric distension secondary to a gallstone in the pyloric channel with inflammatory process centred between pylorus and gallbladder indicating a presumed chole-pyloric fistula. OGD was undertaken and on pyloric intubation, a 1.8cm gallstone appeared to dislodge and was retrieved with roth net. This provides evidence of simple endoscopic resolution of gastric outlet obstruction secondary to a gallstone <2cm proximal to D2. If greater than 2 cm or distal to D2, mechanical lithotripsy may have been required. Failing endoscopic retrieval, surgery would be considered.