Bouveret Syndrome as a Cause of High Intestinal Obstruction in an Older Adult: A Case Report

Abstract

Introduction: Bouveret syndrome is a rare cause of gastric outlet obstruction secondary to the impaction of a gallstone in the duodenum or stomach through a bilioenteric fistula. It accounts for 1–3% of biliary ileus cases and occurs primarily in elderly women with multiple comorbidities. This report describes an exceptional case of Bouveret syndrome complicated by grade III cholangitis and septic shock in a nonagenarian patient, highlighting the diagnostic and therapeutic challenges in frail older adults.Case report: A 91-year-old woman with a history of geriatric frailty was admitted with progressive intolerance to oral intake, nausea, food-containing vomiting, abdominal pain, jaundice, and fever. Laboratory studies showed leukocytosis, anemia, acute kidney injury, hyperbilirubinemia, and elevated liver enzymes. Abdominal computed tomography revealed gastric distension, pneumobilia, and an abrupt narrowing of the duodenal lumen, consistent with mechanical obstruction. Emergency exploratory laparotomy identified multiple gallstones impacted in the duodenum and a cholecystoduodenal fistula. Partial gastrectomy with stone extraction and fistula repair was performed. Histopathological analysis confirmed acute and chronic inflammatory changes associated with the fistula. Despite appropriate surgical management, the patient developed refractory septic shock and died on the second day of intensive care due to multiorgan failure. Conclusion: Bouveret syndrome should be considered in elderly patients presenting with gastric outlet obstruction and signs of cholangitis. This case demonstrates that, even with timely surgical intervention, the prognosis for nonagenarian patients with frailty and sepsis remains poor. The main lesson is the need for a multidisciplinary and individualized approach that carefully evaluates surgical risk, expected benefits, and the patient’s quality of life.