Bouveret’s syndrome—a rare form of gallstone ileus causing death: appearance on post-mortem CT and MRI

Bouveret’s syndrome is a very rare cause of gastric outlet obstruction occurring as a complication of cholelithiasis with cholecystogastric or cholecystoenteric fistula. Without timely diagnosis and intervention Bouveret’s syndrome can be associated with a high rate of morbidity and mortality, with common causes of death including metabolic derangements, aspiration pneumonia and post-operative complications. We report the case of a 67-year-old female found dead in her home with regurgitated gastric contents filling her mouth and nasal cavity. Post-mortem CT and MRI imaging was performed and subsequently revealed a fistulous tract between the gallbladder and proximal duodenum, with impaction of a large obstructing stone in the mid-portion of the duodenum. Post-mortem imaging also revealed findings of gastric outlet obstruction, which was presumed to be a primary contributor to her cause of death.