A331 BOUVERET’S SYNDROME: A RARE CAUSE OF GASTRIC OUTLET OBSTRUCTION
Bibliographic record
Abstract
Bouveret’s syndrome (BS) is a rare variant of a gallstone ileus (itself a rare condition) accounting for less than 5% of all mechanical bowel obstructions. In BS, a gastric outlet obstruction (GOO) is caused by the migration and impaction of a gallstone through a cholecystoduodenal or cholecystogastric fistula and into the duodenum or pylorus of the stomach. The aim of this case report is to bring to light a rare but significant cause of GOO. In addition, we hope to illustrate the need for safe, minimally invasive endoscopic techniques for the treatment of this condition. This was a real case encountered on the gastroenterology ward at a tertiary care hospital in Hamilton, Ontario. We present a case of BS in an 83-year-old woman with multiple comorbidities who presented to the gastrointestinal (GI) service with a week-long history of nausea, vomiting, and epigastric pain. She was found to be severely hypovolemic and with an acute kidney injury. Investigations revealed a cholecystogastric fistula and a gallstone impacted in the patient’s gastric outlet. Endoscopic retrieval of the stone was attempted, although ultimately unsuccessfully. The patient declined surgical intervention and died during this hospitalization. This case illustrates a rare cause for a common presentation, and emphasizes the importance of including BS in the differential diagnosis for nausea and vomiting. It also illustrates the need for minimally invasive treatment techniques as many patients with BS are poor surgical candidates. Endoscopic image of gall stone impacted in patient’s gastric outlet. None
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.003 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".