Endoscopic and surgical management of Bouveret's syndrome complicated by gallstone ileus. Issue 10 (26th October 2021)

• Record Type: Journal Article
• Authors: Varre, Jaya Sai; Wu, Jin Ling; Hopmann, Peter; Ruiz, Oscar; Reddy, Raghuram
• Is Part Of: Journal of surgical case reports. Volume 2021:Issue 10(2021)
• Publication Date: 2021-10-26
• Subjects: Surgery -- Periodicals; Surgery -- Case studies -- Periodicals; 617.005
• DOI: 10.1093/jscr/rjab464
• Languages: English
• ISSNs: 2042-8812

Abstract

Abstract: Bouveret's syndrome is a rare complication that occurs most commonly in elderly patients with multiple comorbidities. It is secondary to an impacted gallstone causing gastric outlet obstruction from a cholecystoduodenal fistula, and there is no defined standardized management in current literature. A 92-year-old woman presents to our tertiary community hospital with abdominal discomfort concerning for bowel obstruction. Computed tomography revealed pneumobilia with a cholecystoduodenal fistula and a large gallstone in the proximal duodenum causing gastric outlet obstruction. The impacted gallstone failed endoscopic extraction with electrohydraulic lithotripsy, and patient subsequently developed distal gallstone ileus requiring exploratory laparotomy and enterolithotomy. This case report examines the need for early coordinated endoscopic and surgical management of a patient with Bouveret's syndrome complicated by gallstone ileus as it is associated with high morbidity and mortality rates.