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Bouveret's syndrome is a rare disorder that causes upper gastrointestinal obstruction, typically in elderly patients with a history of chronic cholelithiasis. We present an unusual case of a 58-year-old woman with untreated vesicular lithiasis who developed Bouveret's syndrome. She presented with severe abdominal pain, nausea, vomiting, and abdominal distension.

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The single anastomosis duodenal-ileal switch (SADI-S) has become a safe alternative to Roux-en-Y gastric bypass (RYGB) in the treatment for morbid obesity. A known complication after bariatric surgery is the development of marginal ulceration. The current literature demonstrates an overwhelmingly low incidence of ulceration in patients who underwent SADI-S.

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Duodenal perforation often presents as an acute onset of abdominal pain and potential complications such as systemic infection, multiple organ system failure, and even death. It can result from various causes, including peptic ulcer disease (PUD), trauma, malignancies, and infections. Prompt diagnosis and timely intervention are critical for better outcomes, though mortality can be high, particularly in delayed cases.

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The morphology of the major duodenal papilla (MDP) plays a crucial role in the selection of the cannulation technique. Primary needle-knife fistulotomy (pNKF) is an advanced cannulation technique is getting more popular because of the lower risk of post-ERCP pancreatitis (PEP). However, few studies have explored the impact of MDP morphology on pNKF outcomes.

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