Bouveret syndrome in a young patient: A case report and review of literature

Figure 1 This computed tomography image is the abdominal cross-sectional image of this patient on March 22, 2022. In the image, an oval high-density gallstone (about 5.0 cm in diameter) was embedded in the proximal duodenum, resulting in significant expansion of the stomach. Edema of duodenal wall and local intestinal lumen stenosis can be seen around the stone. In addition, the gas shadow in the gallbladder suggests that there may be abnormal channels between the gallbladder floor and the gastric antrum, with a little exudation around the gastric antrum.

Figure 2 Endoscopic findings of a large, impacted duodenal stone with peri-lesional ulcer. A: Gastroscopy examination (March 22, 2022): Gastroscopic examination revealed the following findings: Upon advancing the endoscope to the gastric antrum, structural distortion of the antral region was observed A large, irregularly shaped black calculus was identified impacted within the duodenal bulb, exhibiting firm adherence to the surrounding mucosa; B: Gastroscopy examination (March 22, 2022): A huge black stone measuring approximately 3 cm × 2.5 cm was observed. A large ulcer can be seen around the stone at the location indicated by the arrow.

Figure 3 Postoperative abdominal computed tomography scan showing perisurgical exudation and dilatation of the common bile duct. A: Three days after surgery, a follow-up abdominal computed tomography (CT) scan showed slight exudation changes at the surgical site (within the circle); B: Three days after surgery, an abdominal CT scan revealed a dilated common bile duct with a diameter of approximately 1.13 cm.

Figure 4  On the 27^th day after operation, no obvious abnormality was found in abdominal computed tomography.

Figure 5  Histopathology of the resected gallbladder (HE stain, × 40 magnification), showing chronic cholecystitis with mucosal epithelial denudation, necrosis, and transmural hemorrhage.

Figure 6  Two years after discharge (April 21, 2024), the abdominal computed tomography scan showed good recovery in the surgical area.