TY - JOUR T1 - Bouveret syndrome: approaching the obstructive duodenal gallstone JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2022-000945 VL - 7 IS - 1 SP - e000945 AU - Adrian A Coleoglou Centeno AU - Nikhil R Shah AU - Samuel H Cass AU - John P Walker Y1 - 2022/05/01 UR - http://tsaco.bmj.com/content/7/1/e000945.abstract N2 - A 62-year-old woman presented to the emergency department complaining of 2 weeks of right upper quadrant and epigastric pain that acutely worsened 5 days prior to admission. This was associated with nausea and vomiting. Her medical history was significant for morbid obesity (body mass index 67 kg/m2), hypothyroidism, hypertension, congestive heart failure and multiple cerebrovascular events on therapeutic rivaroxaban. Her abdomen demonstrated moderate epigastric tenderness without peritoneal signs. Laboratory values were all normal. CT of the abdomen and pelvis with oral and intravenous contrast showed a large gallstone causing partial gastric outlet obstruction and pneumobilia (figure 1).Figure 1 Multiple cuts of the CT scan showing gastric outlet obstruction caused by a large gallstone in the duodenum (red circle) with associated pneumobilia (yellow arrow).Endoscopic retrieval of stone.Endoscopic electrohydraulic and/or mechanical lithotripsy.Laparotomy with enterolithotomy and cholecystoenteric fistula closure.Laparotomy with enterolithotomy without cholecystoenteric fistula closure.A nasogastric tube (NGT) was inserted for gastric decompression, and a myocardial perfusion scan and echocardiogram were obtained, which demonstrated no myocardial ischemia and normal left ventricular function (ejection fraction of 50% to 55%). She then underwent upper endoscopy during … ER -