An Integrated Systematic Review Of Pathogenesis, Diagnosis, Therapeutics & ,Operative Strategies, And Clinical Outcomes Of Bouveret Syndrome As A Rare Variant Of Gastric Outlet Obstruction

Abstract

Bouveret syndrome constitutes a rare yet clinically formidable manifestation of gastric outlet obstruction arising from the impaction of a migrated gallstone within the proximal duodenum or stomach subsequent to the formation of a cholecystoenteric fistula; the condition is most frequently encountered in elderly individuals with extensive systemic comorbidities and often presents with a constellation of non-specific gastrointestinal symptoms that complicate timely recognition. The diagnostic pathway therefore demands a high index of clinical suspicion supported by carefully sequenced imaging modalities such as computed tomography and refined upper gastrointestinal endoscopy; each modality contributing essential anatomical and pathological clarity. The therapeutic landscape surrounding this disorder is characterized by an ongoing negotiation between minimally invasive endoscopic strategies and more definitive surgical intervention; the former offering reduced physiological burden but demonstrating variable success contingent on stone size and anatomic accessibility while the latter ensures reliable clearance at the cost of operative stress that may exceed the tolerance threshold of the typical patient demographic.

This systematic review synthesizes evidence from thirteen open access clinical reports and observational case studies to delineate the diagnostic reasoning patterns; procedural considerations; and outcome determinants that collectively shape clinical decision making in Bouveret syndrome. The analysis reveals that early diagnosis is fundamentally correlated with procedural success and reduced complication risk; delays in identification significantly heighten inflammatory sequelae; metabolic disturbance; and postoperative morbidity. Endoscopic removal techniques including mechanical lithotripsy and intracorporeal fragmentation exhibit favorable results when stone dimensions remain modest and when technical expertise is available; however surgical enterolithotomy or gastrotomy remains indispensable in cases involving large immobile calculi or complex anatomical fistula configurations. Pharmacotherapeutic stabilization plays a crucial adjunctive role in

correcting electrolyte disturbances; mitigating gastric irritation; and preventing bacterial translocation in the context of inflammatory mucosal compromise.

The review underscores the absence of standardized clinical guidelines and highlights the substantial heterogeneity in intervention practices across institutions of differing resource capacity. The findings demonstrate that management must be individualized through a dynamic interpretive framework integrating anatomical morphology; physiological reserve; and local technical capability rather than adhering to a singular procedural algorithm. Future multi-institutional registries and controlled outcome analyses are required to transition the care of Bouveret syndrome from experiential intuition toward structured evidence-based precision.