A255 CHOLECYSTO-COLONIC FISTULA AND GASTRIC OUTLET OBSTRUCTION DUE TO EXTRINSIC COMPRESSION: A RARE BOUVERET-LIKE SYNDROME

Abstract Background Bouveret syndrome is a rare form of gastric outlet obstruction due to gallstone ileus. It caused by passage large stone from the gallbladder into duodenum via bilio-duodenal fistula causing obstruction. was first described Leon in 1896 and occurs most commonly elderly patients with higher incidence women. In classic syndrome, itself becomes impacted intestinal lumen. A case series 128 cases found only 2 where endoscopic finding extrinsic compression. Purpose To present Cholecysto-colonic compression as Bouveret-like syndrome. Method Chart review conducted including clinical notes, laboratory, radiographic, endoscopy reports. relevant literature conducted. Result(s) 76-year-old female recent hospitalization for weight loss, anemia cognitive decline presented hospital sudden onset vomiting without abdominal pain. She admitted general surgery. CT scan abdomen pelvis were done subhepatic inflammatory mass inflammation proximal partial well between hepatobiliary system loop ascending colon associated pneumobilia. The etiology unclear but thought be infection vs malignancy disease patient put on antibiotic therapy. Due inability tolerate oral intake, she parenteral nutrition. Gastroenterology (GI) service then consulted consideration gastroscopy possible stent placement GI requested an MRI further characterization. This revealed 20mm tract 3 other similarly sized stones passed colon, evidence porta hepatis. Gastroscopy pursued identify any intraluminal compression, which duodenal edema segment pathology. Given that not intraluminal, offered. Surgical options would extensive surgery cholecystectomy, wedge resection colonic resection. her comorbidities, plan made conservative management instead. After weeks admission management, resolved able intake again. Image Conclusion(s) Impacted gallstones chronic cholecystitis can result formation size resultant inflammation, may occur presenting this event, effective strategy safe alternative surgical bypass. Please acknowledge all funding agencies checking applicable boxes below None Disclosure Interest Declared