Sonographic diagnosis of Bouveret's syndrome

A case of Bouveret's syndrome with obstruction of the duodenojejunal flexure diagnosed preoperatively by sonography is presented. A 48‐year‐old man with a history of cholelithiasis presented with colicky pain of 2 days' duration. Real‐time sonography revealed a fluid‐distended stomach and duodenum and a 3.4‐cm bright curvilinear echo with dense shadowing in the duodenojejunal flexure, suggesting a gallstone. In addition, there was pneumobilia and evidence of chronic cholecystitis. The findings were confirmed with CT, which showed a partially calcified gallstone at the duodenojejunal flexure, pneumobilia, and a fistulous communication between the gallbladder and duodenum. At surgery, a large gallstone was found impacted at the duodenojejunal flexure. The stone and gallbladder were successfully removed and the fistula repaired. The sonographic diagnosis of Bouveret's syndrome enabled early surgical intervention. © 2003 Wiley Periodicals, Inc. J Clin Ultrasound 31:163–166, 2003