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Bouveret's Syndrome: Appearance on CT and Upper Gastrointestinal Radiography Before and After Stone Obturation

Ajay K. Singh1,2, Ali Shirkhoda1, Nirish Lal1 and Pallavi Sagar3

1 Department of Diagnostic Radiology, William Beaumont Hospital, 3601 W. 13 Mile Rd., Royal Oak, MI 48073.
3 Department of Internal Medicine, Long Island College Hospital, Brooklyn, NY 11201.



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  		Fig. 1A. —79-year-old woman with Bouveret's syndrome. Upper gastrointestinal radiograph obtained on first admission shows irregular extrinsic impression (arrows) of orthotopic gallstone on duodenal bulb. Note lack of obvious biliary-enteric fistula.

 


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  		Fig. 1B. —79-year-old woman with Bouveret's syndrome. Enhanced CT scan shows pneumobilia (arrow) and calcified gallstone (large arrowhead) abutting duodenal bulb (small arrowhead).

 


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  		Fig. 1C. —79-year-old woman with Bouveret's syndrome. Upper gastrointestinal radiograph obtained 2 months after initial study (A) shows laminated stone (arrow) surrounded by contrast agent (arrowheads) in duodenal bulb, producing partial gastric outlet obstruction.

 


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  		Fig. 1D. —79-year-old woman with Bouveret's syndrome. Enhanced CT scan obtained 2 months after initial study (A) shows large gallstone located in duodenal bulb, surrounded by contrast agent (arrows). Note pneumobilia from biliary-enteric fistula and thickening of gallbladder wall.

 

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