{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T18:29:19Z","timestamp":1780684159137,"version":"3.54.1"},"reference-count":11,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2022,3,15]],"date-time":"2022-03-15T00:00:00Z","timestamp":1647302400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicines"],"abstract":"<jats:p>Our case describes an 83-year-old female who presented with severe abdominal pain, nausea, and bilious emesis of one day\u2019s duration. She had an endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy and percutaneous transhepatic biliary drainage (PTCD) one year prior for choledocholithiasis with acute cholangitis in her home country, Scotland. Unfortunately, while visiting family in the United States, her PTCD became dislodged, and she developed progressive worsening abdominal pain. Computerized tomography of her abdomen showed pneumobilia, perigastric inflammation, a contracted gallbladder, small bowl inflammation with a likely transition point at the mid-jejunum, and a probable duodenal mass. The patient underwent an exploratory laparotomy with intraoperative findings of choledochoduodenal fistula with coincident gastric and small bowel obstruction (SBO) secondary to three large, mixed gallstones. One 3 cm gallstone was located at the pylorus and two (2.3 and 3 cm) gallstones were isolated in the mid-jejunum, with one of those causing isolated transmural pressure necrosis with subsequent perforation. Bouveret syndrome is a rare cause of gastric outlet obstruction (GOO) that manifests via an acquired cholecystoenteric fistula. Our patient presented with a concomitant GOO and SBO with perforation of the mid-jejunum. Timely diagnosis of Bouveret syndrome is essential, as most causes require emergent surgical intervention.<\/jats:p>","DOI":"10.3390\/medicines9030024","type":"journal-article","created":{"date-parts":[[2022,3,16]],"date-time":"2022-03-16T03:36:23Z","timestamp":1647401783000},"page":"24","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Unusual Presentation of Bouveret Syndrome Resulting in Both Gastric Outlet Obstruction and Small Bowel Obstruction with Perforation"],"prefix":"10.3390","volume":"9","author":[{"given":"Jarod","family":"Shelton","sequence":"first","affiliation":[{"name":"WellSpan Health, Department of Surgery, York, PA 17403, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Adeel","family":"Samad","sequence":"additional","affiliation":[{"name":"WellSpan Health, Department of Surgery, York, PA 17403, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Juhng","sequence":"additional","affiliation":[{"name":"WellSpan Health, Department of Surgery, York, PA 17403, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shawn M.","family":"Terry","sequence":"additional","affiliation":[{"name":"WellSpan Health, Department of Surgery, York, PA 17403, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,3,15]]},"reference":[{"key":"ref_1","first-page":"1","article-title":"Stenose du pylore adherent a la vesicle","volume":"16","author":"Bouveret","year":"1896","journal-title":"Rev. Med."},{"key":"ref_2","first-page":"40","article-title":"Bouveret\u2019s Syndrome: An Extensive Summary of the Literature","volume":"1","author":"Osman","year":"2020","journal-title":"Arch. Gastroenterol. Res."},{"key":"ref_3","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. Case"},{"key":"ref_4","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_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":"J. Gastrointest. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"31","DOI":"10.4103\/0971-3026.150136","article-title":"Bouveret syndrome: Primary demonstration of cholecystoduodenal fistula on MR and MRCP study","volume":"25","author":"Negi","year":"2015","journal-title":"Indian J. Radiol. Imaging"},{"key":"ref_7","first-page":"839370","article-title":"Bouveret Syndrome\u2014The Rarest Variant of Gallstone Ileus: A Case Report and Literature Review","volume":"2013","author":"Mavroeidis","year":"2013","journal-title":"Case Rep. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"rjab183","DOI":"10.1093\/jscr\/rjab183","article-title":"Bouveret syndrome\u2014A rare form of gastric outlet obstruction","volume":"2021","author":"Jin","year":"2021","journal-title":"J. Surg. Case Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1148\/rg.2018170076","article-title":"Multimodality imaging, including dual-energy CT, in the evaluation of gallbladder disease","volume":"38","author":"Ratanaprasatporn","year":"2018","journal-title":"Radiographics"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Nickel, F., M\u00fcller-Eschner, M.M., Chu, J., Von Tengg-Kobligk, H., and M\u00fcller-Stich, B.P. (2013). Bouveret\u2019s syndrome: Presentation of two cases with review of the literature and development of a surgical treatment strategy. BMC Surg., 13.","DOI":"10.1186\/1471-2482-13-33"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S140","DOI":"10.1016\/j.hpb.2017.02.315","article-title":"Treatment strategy for management of bouveret syndrome","volume":"19","author":"Khan","year":"2017","journal-title":"HPB"}],"container-title":["Medicines"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2305-6320\/9\/3\/24\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T22:36:42Z","timestamp":1760135802000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2305-6320\/9\/3\/24"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,3,15]]},"references-count":11,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3]]}},"alternative-id":["medicines9030024"],"URL":"https:\/\/doi.org\/10.3390\/medicines9030024","relation":{},"ISSN":["2305-6320"],"issn-type":[{"value":"2305-6320","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,15]]}}}