Hepatobiliary and pancreatic surgery: Bouveret syndrome: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Hepatobiliary and pancreatic surgery: Bouveret syndrome

Sample item

A 74-year-old woman with previous gallstones has repeated vomiting of undigested food for four days. CT shows a distended stomach, air in the biliary tree and a 3 cm calcified stone in the proximal duodenum. What is the diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Bouveret syndrome

A cholecystoduodenal fistula allows a large gallstone to enter the duodenum, where it can lodge and obstruct gastric emptying. This is Bouveret syndrome, a rare form of gallstone ileus. Pneumobilia, gastric distension and an ectopic stone form the diagnostic combination.

Option by option

  • A. Mirizzi syndrome

    Mirizzi syndrome is compression of the common hepatic duct by a stone in the gallbladder neck, causing jaundice.

  • B. Gallstone ileus at the terminal ileum

    Classical gallstone ileus obstructs the narrow terminal ileum and gives small bowel obstruction with a distal site.

  • C. Bouveret syndrome (correct)

    Correct. A gallstone impacted in the proximal duodenum causes gastric outlet obstruction.

  • D. Emphysematous cholecystitis

    Emphysematous cholecystitis shows gas within the gallbladder wall in a diabetic patient and no duodenal stone.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Bouveret syndrome. A cholecystoduodenal fistula allows a large gallstone to enter the duodenum, where it can lodge and obstruct gastric emptying.

Why is "Mirizzi syndrome" not the answer?

Mirizzi syndrome is compression of the common hepatic duct by a stone in the gallbladder neck, causing jaundice.

Why is "Gallstone ileus at the terminal ileum" not the answer?

Classical gallstone ileus obstructs the narrow terminal ileum and gives small bowel obstruction with a distal site.

Why is "Emphysematous cholecystitis" not the answer?

Emphysematous cholecystitis shows gas within the gallbladder wall in a diabetic patient and no duodenal stone.

What concept does this question test?

It tests Hepatobiliary and pancreatic surgery: Bouveret syndrome in General Surgery. This is Bouveret syndrome, a rare form of gallstone ileus. Pneumobilia, gastric distension and an ectopic stone form the diagnostic combination.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Hepatobiliary and pancreatic surgery: Bouveret syndrome?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.