Bouveret´s syndrome as a cause of bleeding from the digestive tract

Abstract

Background: Bouveret's syndrome is an infrequent observation condition, described as gastric outlet obstruction secondary to bile lithium impacted in the duodenum, due to the presence of a bilioenteric fistula. The clinical picture produced by this entity is nonspecific and generally of benign onset, so it may not be diagnosed and precipitate complications over time. Case report: 84-year-old female patient who attends the emergency service in the city of Cartagena, Colombia; by a clinical picture of approximately 3 days of evolution, consisting of 3 melenic stools and 2 haematic vomiting in a coffee cup, associated with occasional epigastric pain at the same time. Discussion: Bouveret's syndrome is an extraordinary complication of biliary stone disease. Melena and melanemesis are signs that suggest the presence of this entity, so the assessment of risk factors is essential to rule out differential diagnoses. Computed tomography is the gold standard for imaging diagnosis, and Rigler's triad can be found. Endoscopic intervention is first-line therapy, reserving open enterolithotomy in case of therapeutic failure or progression of the clinical picture to gallstone ileus..