{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:55:16Z","timestamp":1787028916207,"version":"build-2736575974"},"reference-count":20,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2024,12,24]],"date-time":"2024-12-24T00:00:00Z","timestamp":1734998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Introduction: Bouveret syndrome, a rare and often underdiagnosed variant of gallstone ileus, is characterized by the presence of a large gallstone impacted in the proximal duodenum, resulting in significant gastric outlet obstruction and aerobilia. Early identification of Bouveret syndrome is crucial for developing an appropriate surgical strategy. Case 1: A 76-year-old female underwent a contrast-enhanced abdominal CT scan, which revealed a cholecysto-duodenal fistula with a 3.9 cm \u00d7 4.0 cm \u00d7 4.0 cm gallstone located in the proximal duodenum, along with a distended, fluid-filled stomach and aerobilia. Intraoperatively, due to chronic inflammation and adhesion between the gallbladder and duodenum, a cholecystectomy and fistula repair were performed. Case 2: A 72-year-old female presented with a gastroduodenal passage obstruction confirmed by imaging, which identified a duodeno-biliary fistula. The radiological examination showed oval filling defects in the duodenal bulb consistent with Bouveret\u2019s syndrome, with the largest stone measuring approximately 6 cm in diameter. An enterotomy was performed for stone extraction and was followed by cholecystectomy and duodenal repair with omentoplasty. Conclusions: Bouveret\u2019s syndrome is a rare but clinically significant condition that should be considered in patients presenting with signs of upper gastrointestinal obstruction, particularly in those with a history of chronic cholelithiasis. Early recognition and prompt surgical intervention are essential for obtaining optimal patient outcomes.<\/jats:p>","DOI":"10.3390\/medicina61010005","type":"journal-article","created":{"date-parts":[[2024,12,24]],"date-time":"2024-12-24T10:58:32Z","timestamp":1735037912000},"page":"5","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Bouveret\u2019s Syndrome as a Rare Life-Threatening Complication of Gallstone Disease\u2014A Surgical Problem: Two Case Reports"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2955-9070","authenticated-orcid":false,"given":"Nebojsa S.","family":"Ignjatovic","sequence":"first","affiliation":[{"name":"Clinic for Digestive Surgery, University Clinical Centre Nis, 18000 Nis, Serbia"},{"name":"Medical Faculty, University of Nis, 18000 Nis, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0316-7047","authenticated-orcid":false,"given":"Ilija D.","family":"Golubovic","sequence":"additional","affiliation":[{"name":"Clinic for Digestive Surgery, University Clinical Centre Nis, 18000 Nis, Serbia"},{"name":"Medical Faculty, University of Nis, 18000 Nis, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9986-2991","authenticated-orcid":false,"given":"Miodrag N.","family":"Djordjevic","sequence":"additional","affiliation":[{"name":"Medical Faculty, University of Nis, 18000 Nis, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0441-7335","authenticated-orcid":false,"given":"Marko M.","family":"Stojanovic","sequence":"additional","affiliation":[{"name":"Medical Faculty, University of Nis, 18000 Nis, Serbia"},{"name":"Clinic for Gastreoenterology, University Clinical Centre Nis, 18000 Nis, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0432-6142","authenticated-orcid":false,"given":"Daniela A.","family":"Benedeto Stojanov","sequence":"additional","affiliation":[{"name":"Medical Faculty, University of Nis, 18000 Nis, Serbia"},{"name":"Clinic for Gastreoenterology, University Clinical Centre Nis, 18000 Nis, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0079-2522","authenticated-orcid":false,"given":"Jelena S.","family":"Ignjatovic","sequence":"additional","affiliation":[{"name":"Medical Faculty, University of Nis, 18000 Nis, Serbia"},{"name":"Clinic for Radiolology, University Clinical Centre Nis, 18000 Nis, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0230-6735","authenticated-orcid":false,"given":"Jelena D.","family":"Zivadinovic","sequence":"additional","affiliation":[{"name":"Medical Faculty, University of Nis, 18000 Nis, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1360-6709","authenticated-orcid":false,"given":"Sonja","family":"Golubovic","sequence":"additional","affiliation":[{"name":"Medical Faculty, University of Nis, 18000 Nis, Serbia"},{"name":"Clinic for Radiolology, University Clinical Centre Nis, 18000 Nis, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,12,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"69","DOI":"10.2147\/CEG.S132069","article-title":"Bouveret syndrome: Current management strategies","volume":"11","author":"Caldwell","year":"2018","journal-title":"Clin. Exp. Gastroenterol."},{"key":"ref_2","first-page":"283","article-title":"Bouveret syndrome\u2014An exceptional complication of a very frequent disease","volume":"111","author":"Gavrila","year":"2016","journal-title":"PubMed"},{"key":"ref_3","first-page":"125","article-title":"Bouveret\u2019s syndrome on FDG PET\/CT: A rare life-threatening complication of gallstone disease","volume":"33","author":"Aras","year":"2013","journal-title":"Rev. Espa\u00f1ola De Med. Nucl. E Imagen Mol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"73","DOI":"10.3121\/cmr.2018.1430","article-title":"A Multidisciplinary Approach to Management of Bouveret Syndrome","volume":"16","author":"Watson","year":"2018","journal-title":"Clin. Med. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"65","DOI":"10.4240\/wjgs.v8.i1.65","article-title":"Gallstone ileus, clinical presentation, diagnostic and treatment approach","volume":"8","year":"2016","journal-title":"World J. Gastrointest. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1016\/j.amsu.2015.02.001","article-title":"A rare presentation of gastric outlet obstruction (GOO)\u2014The Bouveret\u2019s syndrome","volume":"4","author":"Kalwaniya","year":"2015","journal-title":"Ann. Med. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1007\/s13126-018-0462-2","article-title":"Gastric outlet obstruction by a large gallstone (Bouveret\u2019s Syndrome)","volume":"90","author":"Kalliakmanis","year":"2018","journal-title":"Hell. J. Surg."},{"key":"ref_8","first-page":"434","article-title":"A rare presentation of gallstones: Bouveret\u00b4s syndrome, a case report","volume":"108","author":"Otaegui","year":"2016","journal-title":"PubMed"},{"key":"ref_9","first-page":"34","article-title":"The curious case of a missing gallbladder: An unusual presentation of a cholecystoduodenal fistula","volume":"12","author":"Surapaneni","year":"2021","journal-title":"Avicenna J. Med."},{"key":"ref_10","first-page":"24768","article-title":"Bouveret Syndrome: A Rare case and Review of the literature","volume":"14","author":"Probert","year":"2022","journal-title":"Cureus"},{"key":"ref_11","first-page":"42","article-title":"Bouvaret sindrom\u2013retka komplikacija bilijarne litijaze","volume":"12","author":"Stojanov","year":"2003","journal-title":"Radiol. Arch. Srb."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2482-13-33","article-title":"Bouveret\u2019s syndrome: Presentation of two cases with review of the literature and development of a surgical treatment strategy","volume":"13","author":"Nickel","year":"2013","journal-title":"BMC Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"4144","DOI":"10.12998\/wjcc.v7.i23.4144","article-title":"Bouveret syndrome: A case report","volume":"7","author":"Wang","year":"2019","journal-title":"World J. Clin. Cases"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s10140-017-1568-5","article-title":"Clinical and radiological diagnosis of gallstone ileus: A mini review","volume":"25","author":"Chang","year":"2017","journal-title":"Emerg. Radiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/S1665-2681(19)31937-4","article-title":"Bouveret\u2019s syndrome. Narrative review","volume":"6","author":"Koulaouzidis","year":"2007","journal-title":"Ann. Hepatol."},{"key":"ref_16","first-page":"4414","article-title":"Bouveret\u2019s Syndrome","volume":"11","author":"Philipose","year":"2019","journal-title":"Cureus"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1720","DOI":"10.1007\/s11605-013-2244-z","article-title":"Bouveret syndrome","volume":"17","author":"Shah","year":"2013","journal-title":"J. Gastrointest. Surg."},{"key":"ref_18","first-page":"1813","article-title":"Bouveret\u2019s syndrome: A rare presentation of gastric outlet obstruction","volume":"17","author":"Yu","year":"2019","journal-title":"Exp. Ther. Med."},{"key":"ref_19","first-page":"2299","article-title":"Bouveret\u2019s Syndrome: Literature Review","volume":"10","author":"Haddad","year":"2018","journal-title":"Cureus"},{"key":"ref_20","first-page":"27519","article-title":"Bouveret\u2019s Syndrome: A case series.and literature review on a gallstone disease causing gastric outlet obstruction","volume":"14","author":"Adnan","year":"2022","journal-title":"Cureus"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/1\/5\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:59:32Z","timestamp":1760115572000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/61\/1\/5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,24]]},"references-count":20,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,1]]}},"alternative-id":["medicina61010005"],"URL":"https:\/\/doi.org\/10.3390\/medicina61010005","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12,24]]}}}