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Clinical Case Summary

Fistulization between the gallbladder and the gastrointestinal tract is a rare clinical entity, which may result in the migration of a calculus along the path. It typically presents with nonspecific symptoms, making its diagnosis difficult.
Clinical case: A 65-year-old male went to the emergency department due to a 3 day history of vomiting and prolonged abdominal pain, postprandial fullness, anorexia and weight loss for 3 months. He presented with pain in the upper quadrants of the abdomen and right lower quadrant. There was a mild leukocytosis, anemia and a C-reactive protein of 3.99mg/dL. An abdominal ultrasound and CT scan showed several hypodense hepatic nodules, exuberant cholelithiasis without parietal gallbladder thickening, and heterogeneous intragastric content at the level of the antrum, conditioning upstream distension. Abdominal MRI was performed and characterized the liver lesions as hemangiomas. It also identified gastric, duodenal, and proximal jejunal distension, with parietal hyperenhancement of the duodenal bulb and fistulization between the gallbladder and duodenum. Due to food intolerance and persistent vomiting, an upper digestive endoscopy was performed, which identified a voluminous calculus (~5-7cm in diameter) in the gastric lumen, non-obstructive, and an apparent orifice at the bulbar level, possibly corresponding to the previously described fistula. No identification of gastroduodenal obstructive lesions justifying jejunal dilation were identified. He underwent exploratory laparotomy, and two stones were identified, one at the gastric level and the other at the ileal level close to the ileocecal valve. A gastrolithotomy and enterolithotomy were performed, which were complicated by anastomotic dehiscence and septic shock. The present case illustrates an intestinal and gastric obstruction conditioned by fistulization and subsequent migration of a calculus between the gallbladder and the gastrointestinal tract.

References

Brabender D, Sheikh MR, Zielsdorf S. Bouveret's Syndrome. J Gastrointest Surg. 2022 Jan;26(1):258-260. doi: 10.1007/s11605-021-05086-y. Epub 2021 Jul 29. PMID: 34327657
Le Mouel JP, Thiebault H, Hakim S. Bouveret's Syndrome. Clin Gastroenterol Hepatol. 2019 May;17(6):e55. doi: 10.1016/j.cgh.2018.02.006. Epub 2018 Feb 9. PMID: 29432920
Lai YT, Wu PH. Gallstone Ileus. N Engl J Med. 2022 Sep 8;387(10):924. doi: 10.1056/NEJMicm2204208. Epub 2022 Sep 3. PMID: 36053241
Bär F, Roblick U, Lehnert H. Gallstone ileus. Clin Gastroenterol Hepatol. 2011 Oct;9(10):A22. doi: 10.1016/j.cgh.2011.03.028. Epub 2011 Mar 31. PMID: 21458596

Disclosure

CHOLECYSTODUODENAL FISTULA ASSOCIATED WITH BOUVERET SYNDROME AND GALLSTONE ILEUS – A CASE REPORT

Ângela Domingues 1, Ricardo Araújo 1, Eugenia Cancela 1, Catarina Silva 1, Sofia Ventura 1, Cláudio Rodrigues 1, Caroline Soares 1, Americo Jeronimo Taveira da Silva 1

1 Centro Hospitalar Tondela-Viseu, Viseu, Portugal

Conference

UEG Week Copenhagen 2023

Topics

Hepatobiliary

Submission format

Clinical Case

Session

PP 12 Clinical Cases (Posters)

Published

2023

UEG Online Course

accredited

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Modern guideline development has evolved over the last 20 years to improve quality of clinical guidelines.

This course aims to provide basic knowledge of developing guidelines. It will explain the process of how to go about writing protocol, the very basics regarding GRADE, and what you need to do after completing a guideline. It will also signpost you to other courses organised by Guideline International Network.

The course includes comprehensive PPT slides and bespoke video presentations. The combined material has a total duration of approximately 30 minutes. The estimated time needed to complete the course, including the final assessment, is 45 minutes.

Target audience

This course is suitable for gastroenterologists in training, but is also appropriate for physicians in other disciplines and surgeons , as well as nurses, biotechnicians and advanced-years’ medical students who have an interest in developing guidelines.

Enrol Part 2: How to develop guidelines - Part 2

How to develop guidelines - Part 1

Yasuko Maeda, Adele Sayers, Ana Dugic

Event

How to develop guidelines - Part 1

Topics

Education & Training

Accreditation status

accredited

Duration

45 minutes

Published

2024

UEG Online Course

accredited

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This comprehensive course introduces participants to the transformative role of artificial intelligence in gastroenterology. Designed for healthcare professionals, the course covers fundamental AI concepts, clinical applications, and research perspectives. Key topics include machine learning techniques, AI-assisted diagnostics, and the integration of AI systems in clinical practice. Participants will explore the benefits and challenges of AI adoption, ethical considerations, and the regulatory landscape, with an emphasis on evidence-based decision-making.

The course includes extensive PowerPoint presentations and tailored video lectures. Examples are used to demonstrate real-world applications of the material. The total duration of the course is approximately 50 minutes, with an estimated completion time of 60 minutes, including the final assessment.

A Primer for Artificial Intelligence in Gastroenterology

Cem Simsek, Giulio Antonelli, Alanna Ebigbo

Event

A Primer for Artificial Intelligence in Gastroenterology

Topics

Endoscopy

Accreditation status

accredited

Duration

1 hour

Published

2025

UEG Online Course

accredited

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This course builds on foundational concepts to examine contemporary mechanisms driving GORD phenotypes. We revisit key epidemiological and clinical distinctions before exploring gastric physiology, including postprandial acid–bile dynamics, H. pylori-related acid output, motility patterns, obesity-related changes, and post-surgical anatomy. Oesophagogastric junction competence (LES pressure, TLESRs, hiatal hernia) and refluxate characteristics (acidic to gaseous; PPI-modified) are discussed with emphasis on symptom generation. We detail epithelial biology, micro- and macroinflammatory responses across NERD and erosive disease, and advances in nociceptive signalling, receptor expression, central modulation, and hypervigilance. Key clinical studies, cytokine-driven pathways, and emerging therapeutic approaches are highlighted. The course concludes with implications for diagnosis, phenotype-guided management, and outstanding research questions.

GORD Pathophysiology - Part 2

Edoardo Savarino, Ahsen Ustaoglu

Event

GORD Pathophysiology Part 2

Topics

Neurogastroenterology & Motility

Accreditation status

accredited

Duration

1 hour

Published

2026

UEG Online Course

accredited

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Proctologic disorders are a widespread problem—their high incidence means that many different healthcare professionals (e.g. gastroenterologists, surgeons, dermatologists, nurses, young residents, etc.) will be confronted by patients complaining about a proctologic disease.

This course by European Society of Coloproctology (ESCP) experts Harald Rosen, Janindra Warusavitarne and Nuha Yassin provides the most recent state-of-the-art information on the common proctologic disorders of haemorrhoids and perianal skin conditions.

Learning objectives

To understand how to reach a conclusive diagnosis of GORD
To know how to reach a conclusive diagnosis of no GORD
To understand how to deal with an inconclusive diagnosis

Target audience

This course is suitable for gastroenterologists and surgeons in training, but is also appropriate for other physicians, as well as nurses, biotechnicians and medical students who have an interest in coloproctology.

Proctology — haemorrhoids and perianal skin conditions

Harald Rosen, Janindra Warusavitarne, Nuha Yassin

Event

Proctology — haemorrhoids and perianal skin conditions

Topics

Surgery

Accreditation status

accredited

Duration

1 hour

Published

2021

UEG Online Course

accredited

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About this online course

Stem cells are primitive and undifferentiated cells in human tissues (foetal and adult) with self-renewal, multipotency and longevity properties. They are responsible for cellular regeneration within the gastrointestinal tract but also play an essential role in different GI pathologies (e.g., Barrett’s oesophagus).

A gastroenterologist’s guide to stem cells, by Simon Leedham and Stuart McDonalds, covers the basic definitions of stem cells and their different locations in the gastrointestinal tract, homeostasis, the role of stem cells in intestinal regeneration, metaplasia, and tumour heterogeneity. The course includes comprehensive PPT slides, and bespoke video presentations filmed in London in December 2022. Figures, schemes, and further readings are included for consideration. The combined material has a total duration of approximately 60 minutes. The estimated time needed to complete the course, including the final assessment, is 60 minutes.

Target audience

This course is suitable for gastroenterologists in training, but is also appropriate for nurses, basic scientist in gastroenterology, medical students with interest in gastroenterology as well as other physicians (oncology, regenerative medicine, research).