Bouveret syndrome: evaluation with multidetector computed tomography and contrast-enhanced magnetic resonance cholangiopancreatography

Abstract

Cholecystenteric fistula is one of the rarest complications of biliary lithiasis, with a frequency of less than 1%. Bouveret syndrome is a gastric outlet obstruction produced by gallstone(s) located in the distal stomach or proximal duodenum. The route of gallstone migration to the bowel is most commonly via a cholecystoduodenal fistula; however, fistulization of the stomach is a rarer variation. Early diagnosis of this situation is crucial to reduce morbidity and mortality. In this report, we present a patient with cholecystogastric fistula and Bouveret syndrome. To our knowledge, there is no published paper in the literature related to the diagnosis of Bouveret syndrome with multidetector computed tomography (MDCT) (64 detectors) and/or contrast-enhanced magnetic resonance cholangiopancreatography (CE-MRCP). Our aim was to discuss the efficacy of MDCT and CE-MRCP in the detection and evaluation of cholecystenteric fistulas. We showed the exact localization and relation of biliary stones and the fistula by MDCT and CE-MRCP. We also evaluated the biliary system with CE-MRCP physiologically. In conclusion, when biliary lithiasis and ileus are detected in plain radiography, the first-line diagnostic tool should be MDCT. In complicated cases or when biliary obstruction is suspected, CE-MRCP can give important morphological and physiological information regarding the whole abdomen and biliary system.