Author:

Abstract:

The patient presented himself at the emergency room with a history of epigastralgia, nausea and vomiting since approximately four days and was subsequently transferred to our gastroenterology unit. His complaints worsened with increasing abdominal bloating and unability to defecate for two days, though flatulence still occurred. His medical record comprised diabetes mellitus type 2, chronic renal impairment, chronic obstructive pulmonary disease, reflux oesophagitis and asymptomatic chole-cystolithiasis. On clinical examination, epigastric pressure pain and abdominal bloating without peritoneal irritation were noted. Hematological screening revealed a marked leucocytosis, hyperglycemia, a slightly elevated creatinine, normal electrolytesand a normal liver function. Ultrasonographic evaluation of the entire abdomen indicated an entirely shrinked and partially air-filled gall bladder, some hyperreflective zones and a normal bladder wall. The biliary ducts were not dilated. The abdominal radiography was normal except for a massive aero-gastria. An endoscopic evaluation of the upper digestive tract remained inconclusive, though a congestive mass near the pylorus was seen. The stomach was dilated and filled with a watery fluid, which was immediately aspirated. We suggested a gastric outlet obstruction, which was confirmed by abdominal computed tomography (CT). A massive gall stone was visualized in the stomach and a biliogastric fistula discovered. This uncommon presentation of a gastric outlet obstruction is in the literature referred to as the "Bouveret syndrome".