A Gallstone Masquerading as Hepatic Decompensation: A Case of Bouveret Syndrome

Bouveret syndrome is a rare form of gallstone ileus caused by impaction of a gallstone in the pylorus or proximal duodenum after migration through a bilioenteric fistula.Its nonspecific presentation can mimic hepatic decompensation in patients with chronic liver disease.We report the case of a 55-year-old man with alcohol-related liver disease who presented with jaundice, abdominal distension, abdominal pain, constipation, and bilious vomiting, with renal dysfunction and ascites.Contrast-enhanced CT showed acute calculous cholecystitis with sealed-off gallbladder perforation, a probable cholecystoenteric fistula, and a 25-mm gallstone impacted in the second part of the duodenum causing gastric outlet obstruction.The patient was managed conservatively in view of high surgical risk.He improved clinically, and repeat CT demonstrated spontaneous passage of the gallstone.This was a rare case of abdominal pain and jaundice in a patient with decompensated chronic liver disease.Early cross-sectional imaging is important for diagnosis and individualized management.