Combined Bouveret and Type IV Mirizzi Syndromes Treated by One-Stage Biliary and Gastrointestinal Reconstruction: A Case Report

Bouveret syndrome is a rare condition that occurs due to migration of a gallstone into the duodenum through fistula formation between the gallbladder and duodenum, leading to gastric outlet obstruction. Mirizzi's syndrome is a rare condition where cholelithiasis leads to external compression or even erosion into the common hepatic duct (CHD). Here, we present a unique case that showcases severe presentations of both phenomena in a male presenting with sudden-onset pain and vomiting for 3 h. The decision for a one-stage approach of fistula takedown, cholecystectomy, duodenectomy, Roux-en-Y, and hepaticojejunostomy was made given the patient's young age and good health status after failure of stone retrieval through esophagogastroduodenoscopy (EGD). Beyond anatomic necessity, simultaneous stone clearance and cholecystectomy avoid the recurrent lithiasis, interval cholecystitis, and ongoing erosion into adjacent structures associated with a staged approach. This case underscores that operative planning should be guided by anatomic complexity rather than age or ASA class alone, provided patient selection is appropriate.