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Bouveret Syndrome - Symptoms, Diagnosis, and Treatment

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Bouveret syndrome is a rare condition that arises from gallstone complications. This article provides you with a detailed description of it.

Written by

Dr. Gayathri P

Medically reviewed by

Dr. Jagdish Singh

Published At January 2, 2023
Reviewed AtFebruary 20, 2023


The gallbladder is an essential organ in our system that stores bile (digestive juice) and releases it to the small bowel to aid in fat digestion. The store bile may get hardened to form stones in a few instances. These stones may clear up gradually, but the larger ones cause severe complications. One such complication is Bouveret syndrome. Read below to know more.

What Is Bouveret Syndrome?

Bouveret syndrome denotes a gastric outlet blockage that occurs due to the impaction of a large gallbladder stone in the stomach or small bowel. Due to various reasons, a large stone may form in the gallbladder, which may enter the small bowel or stomach through an abnormal passage (fistula). It leads to obstruction of the gastric outlet.

Is Bouveret Syndrome Common?

M. Beassier, a French Surgeon, first reported the disorder in 1770. Later, a French physician named L. Bouveret published two reports on this condition in 1896. However, reports show that only 315 cases were noted between 1967 to 2016. It indicates the rare nature of Bouveret syndrome. In addition, it accounts for 1 to 3 % of all gallstone obstructions.

What Are the Risk Factors for Bouveret Syndrome?

Bouveret syndrome is considered to be a severe complication of a gallbladder stone (cholelithiasis).

However, the following factors increase the risk of it:

  • Female gender.

  • Advanced age (above 60 years).

  • History of cholelithiasis, jaundice, and gallstone in the bile duct.

  • Gallstones larger than 2 cm to 8 cm.

What Are the Signs and Symptoms?

The intensity of the symptoms keeps fluctuating, and it includes:

  • Nausea.

  • Vomiting.

  • Abdominal swelling.

  • Pain mainly in the right upper portion of the abdomen.

  • Weight loss.

  • Dehydration.

  • Vomiting blood may happen less frequently.

How Is Bouveret Syndrome Diagnosed?

1) Physical Examination - The physician may look for abdominal swelling, pain, dry mucous membranes, and other signs of jaundice. But, these findings do not confirm the diagnosis, and the following investigations are necessary.

2) Plain Radiograph - The abdominal radiographs are not so specific and accurate in diagnosing Bouveret syndrome. The other findings that are less noticed include:

  • Bowel obstruction.

  • Enlarged stomach.

  • Abnormal location of gallstone.

  • Accumulation of gas in the gallbladder and bowel.

3) Computed Tomography - A particular and accurate imaging technique in detecting Bouveret syndrome. It gives a detailed view of the following:

  • Number and size of gallstones present.

  • Fistula.

  • Any abscess, if present.

  • Surrounding tissues.

The classic triad of Bouveret syndrome, Rigler’s triad, is usually visualized in 40 to 50 % of cases. It consists of the following:

  • Ectopic location of gallbladder.

  • Bowel obstruction.

  • Presence of gas within the bile ducts and bowel.

4) Magnetic Resonance Cholangiopancreatography (MRCP) is a type of magnetic resonance imaging (MRI) that does not require a contrast agent like the typical MRI. It is highly efficient in differentiating stones from other fluids and provides a detailed image of the fistula.

5) Esophagogastroduodenoscopy (EGD) - The healthcare specialist may insert a flexible tube into the mouth, passing the food pipe to the stomach. It provides a detailed image of the stomach and small bowel. It also aids in treating other conditions of the upper gastrointestinal tract.

What Are the Similar Conditions?

  • The inflammation of the digestive tract characterizes Crohn’s disease. It produces symptoms like fatigue, abdominal pain, fever, loss of weight, etc. Similar to Bouveret syndrome, the symptoms occur in episodes.

  • Peptic ulcer disease causes ulcers on the stomach and small bowel lining. Stress, smoking, alcohol consumption, certain medications, and bacteria are responsible for causing peptic ulcers.

  • Erosive gastritis refers to the inflammation of the stomach's mucosal lining that leads to the formation of sores on it. Severe ulcers require immediate treatment.

  • The obstruction of the small bowel characterizes the duodenal web. The affected individual may have upper abdominal pain, vomiting, and abdominal swelling.

Can Bouveret Syndrome Be Treated?

1) Endoscopy - It is the most preferred treatment as it is minimally invasive. The first endoscopic technique for visualizing and removing gallstones was successful in 1985. But, endoscopy is productive in removing stones of smaller sizes. In addition, the prognosis of treatment is less compared to surgery.

2) Lithotripsy is a non-surgical method that involves crushing the stone and then removing them with nets, baskets, or other instruments.

  • Electrohydraulic lithotripsy is also used to remove large stones, whereas high-intensity shock waves are used to break the storm into smaller particles and remove them. Stones larger than 2.5 cm are effectively removed by lithotripsy procedure. However, the main drawback is that bleeding and perforation may occur if shock waves are focused on the bowel wall during the procedure.

  • Laser lithotripsy is considered safe in treating gallstones as it focuses the high energy on the stone, and the tissues are less damaged. It provides excellent access for the healthcare specialist to control the laser application. Holmium and Neodymium lasers are approved by the Food and Drug Administration (FDA) to be used in the laser lithotripsy technique.

3) Surgery - In the past decades, surgery was the primary procedure in treating Bouveret syndrome. However, it is not advisable in elderly patients and is considered only if the endoscopic procedure did not help the effective removal of gallstones.

  • Cholecystectomy: If there is a high risk and complications associated with the gallstones, the doctor may suggest the surgical removal of the gallbladder. The fistula is also repaired, along with removing the gallbladder if required.

What Are the Complications of Bouveret Syndrome?

The severe obstruction of the gastric outlet leads to the following complications if left untreated:

  • Dehydration (loss of body fluids).

  • Anorexia.

  • Electrolyte imbalance.

  • Nutritional deficiency.

  • Bowel perforation (development of a hole in the intestine wall).


Bouveret syndrome is an infrequent complication of gallstones, and it requires high knowledge of the healthcare specialist in diagnosing such conditions. The obstruction of the gastric outlet is a critical feature in diagnosis. However, with the help of endoscopy, the doctor may confirm Bouveret syndrome. In addition, the use of endoscopy and lithotripsy in gallstone retrieval has shown high success rates. Surgery is also an alternate option if the other mentioned procedures have not worked.

Frequently Asked Questions


How Is Bouveret Syndrome Managed?

The management of Bouveret syndrome involves eliminating the obstructive gallstone. This can be done through surgical and non-surgical methods. In the case of surgical methods, open or laparoscopic surgery is done, where the doctor accesses the abdomen without any incision, on the skin. Another method is the non-surgical endoscopic method which allows access to the doctor to view the inside of the abdomen. 


What Is Bouveret Syndrome Gastric Outlet Obstruction?

Bouveret syndrome is characterized by gastric outlet obstruction secondary to gallstones in the stomach. Gastric outlet obstruction is caused due to the formation of cholecystoduodenal fistula. This condition is present with pain, nausea, and vomiting.


Is Gallstone Ileus Common?

Gallstone ileus occurs in 0.3 % to 0.5 % of people with gallstone. Gallstone ileus is a condition that causes mechanical bowel obstruction. It affects older people with other medical conditions. It is usually caused due to gallstone impaction in the ileum. 


Bouveret Syndrome Is Named After Whom?

Bouveret syndrome is named after the French physician Leon Bouveret in the year 1869. This condition concerns gastric outlet obstruction secondary to gallstone impaction.


How Mirizzi Varies From Bouveret Syndrome?

Mirizzin usually displays jaundice caused due to external compression over the bile duct by an impacted gallstone. In the case of Bouveret syndrome, there is the presence of gastric outlet obstruction caused due to large stone present in the duodenum.


What Is Meant by Gallstone Ileus Bouveret Syndrome?

Bouveret syndrome is a rare cause of gallstone ileus, which displays obstruction of the gastric outlet caused due to gallstone lodgment in the stomach or duodenum. It occurs in one to three percent of people who experience gallstone ileus.


What Is the Surgical Treatment for Gallstone Ileus Called As?

Cholecystectomy is the surgical treatment that is recommended for the treatment of gallstone ileus. This procedure involves surgical removal of the gall bladder, a pear-shaped organ just below the liver on the right side of the abdomen.


Where Does Gallstone Ileus Occur?

Gallstone ileus can occur anywhere in the gastrointestinal tract, but in about 60 % of cases, it occurs in the duodenum. In very rare cases, gallstone ileus can occur in the colon.


What Is the Risk Factor Associated With Gallstone Ileus?

Some risk factors are
- Aging.
- Female gender.
- Obesity.
- Hyperinsulinemia is excessive insulin in the blood.
- Dyslipidemia is the imbalance of cholesterol and lipids.


A Dead Gall Bladder Is Known As?

A dead gall bladder is called gangrenous cholecystitis, which can result in severe infection which can spread throughout the body. Without proper treatment, cholecystitis can result in complications and death of the gall bladder tissue, known as gangrenous cholecystitis.


How Can a Person Survive Without a Gallbladder?

A person can lead a normal life even in the absence of a gall bladder, as the liver can produce the required amount of bile that is needed to digest food. Due to the absence of a gall bladder, the bile cannot be stored. Instead, it continuously drips into the digestive tract.
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Dr. Jagdish Singh
Dr. Jagdish Singh

Medical Gastroenterology


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