Endoscopic and surgical management of Bouveret’s syndrome complicated by gallstone ileus

Varre, Jaya Sai; Wu, Jin; Hopmann, Peter; Ruiz, Oscar; Reddy, Raghuram

doi:10.1093/jscr/rjab464

Cited by 4 publications

(2 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Further, one drawback of the endoscopic treatment of large proximal impacted gallstones is the possibility of distal migration of its fragments resulting in secondary gallstone ileus [ 2 , 4 ]. Other complications associated with endoscopic treatment include bowel injury and the risk of perforation [ 10 ]. Our patient was neither a candidate for endoscopic treatment nor extracorporeal shock-wave lithotripsy, given his unique clinical presentation with a concurrent proximal and distal obstruction along with morbid obesity.…”

Section: Discussionmentioning

confidence: 99%

Synchronous Gallstone Ileus and Bouveret’s Syndrome: A Report of Two Rare Concurrent Complications of Gallstone Disease

Pinheiro¹,

Logrado²,

Aveiro³

et al. 2023

Cureus

View full text Add to dashboard Cite

Cholecystoenteric fistulas occur as a result of a chronic inflammatory insult involving the gallbladder and the erosion of both its wall and a bowel segment. When the fistula develops, it creates a pathway for gallstones to migrate and cause an intestinal obstruction, known as gallstone ileus. When it obstructs the gastric outlet, a proximal variant of gallstone ileus occurs, known as Bouveret's syndrome.A 65-year-old man presented to the emergency department with a three-day history of epigastric and right upper quadrant pain and persistent vomiting, preceded by unintentional weight loss of 15 kg over three months. Endoscopic and complementary imaging studies identified a concurrent gastric outlet obstruction caused by a lodged gallstone in the duodenal bulb and gallstone ileus.The patient underwent an urgent exploratory laparotomy and was submitted to an enterolithotomy and gastrolithotomy. Due to a sudden deterioration on the fourth postoperative day, he underwent an emergent re-laparotomy that found fecal peritonitis and complete dehiscence of both closures. The patient was then managed with damage control surgery. An atypical gastric resection and enterectomy of the distal ileum were performed and the patient was admitted to the intensive care unit in temporary abdominal closure (laparostomy). The patient failed to improve and died on the same day. Ultimately, the patient's multiple comorbidities, including morbid obesity, malnutrition, and diabetes, contributed to poor tissue healing and the fatal outcome.Gallstone ileus and Bouveret's syndrome are two rare complications of cholecystoduodenal fistulas that have not yet been reported to occur simultaneously. Both intestinal and gastric obstruction makes the surgical approach the first-line treatment.

show abstract

Section: Discussionmentioning

confidence: 99%

Synchronous Gallstone Ileus and Bouveret’s Syndrome: A Report of Two Rare Concurrent Complications of Gallstone Disease

Pinheiro¹,

Logrado²,

Aveiro³

et al. 2023

Cureus

View full text Add to dashboard Cite

show abstract

“…Even though the success rate of endoscopic treatment is less than 10%, endoscopy should be considered before surgery [ 8 ]. This is generally because of the higher mortality rate from surgery compared to endoscopy (17.3% vs. 1.6%, p=0.003) [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

A Case of Bouveret’s Syndrome Treated With Holmium:Yttrium-Aluminum-Garnet Laser

Jaroenlapnopparat¹,

Demirjian²,

Brugge³

et al. 2023

Cureus

View full text Add to dashboard Cite

Bouveret's syndrome is a rare form of gallstone ileus described as a gastric outlet obstruction from a gallstone that travels from the gallbladder to the bowel through a bilioenteric fistula. Despite its rarity, the mortality rate of this condition is high. Endoscopic treatment is preferred over surgery due to the association with lower mortality rate. To date, there are limited data about the application of holmium:yttriumaluminum-garnet (YAG) laser lithotripsy for fragmentation of gallstones in Bouveret's syndrome. We present the case of a 74-year-old man with multiple cardiac comorbidities who presented with periumbilical pain, decreased appetite, and vomiting. The patient had previously been admitted three months prior with acute cholecystitis, and a cholecystostomy tube was placed. He had leukocytosis and purulent discharge in his cholecystostomy bag. Computed tomography (CT) scan of the abdomen and pelvis showed a change in the position of a previously seen large gallstone from the neck of the gallbladder on the last admission, to the lumen of the duodenal bulb on this admission. This indicated the development of a cholecystoduodenal fistula, with the stone passing through this fistula into the duodenal bulb, causing the complete obstruction. Endoscopic treatment was recommended by the surgery team due to cardiac comorbidities and the significant friability of the tissue requiring laparotomy. Initial endoscopic evaluation showed complete obstruction of the duodenal bulb by a large smooth stone, not allowing passage of a guidewire beyond the stone. Therefore, holmium:YAG laser lithotripsy was used. After two sessions of laser therapy, four days apart, each breaking a pigmented and calcified stone, it eventually passed through the small bowel into the colon, relieving the obstruction. The patient had a favorable outcome and did not require surgery. This case report shows that holmium:YAG laser lithotripsy is capable of delivering favorable outcomes, as seen in a patient with a heavily calcified and pigmented stone, older age, and multiple comorbidities. Holmium:YAG laser could be considered for use with endoscopic equipment for future management of this condition, especially in patients who have medical comorbidities and heavily calcified gallstones.

show abstract

Endoscopic versus surgical management in Bouveret’s syndrome: A case series

Simões Bolota,

Leandro,

Cotovio

et al. 2024

Case Rep Int

View full text Add to dashboard Cite

Introduction: Bouveret’s syndrome is a rare entity, accounting for 1–3% of gallstone ileus cases. It is more common in elderly females and is associated with significant morbidity and mortality. It presents with epigastric pain, nausea, and vomiting in patients with concurrent cholelithiasis. Given the nonspecific symptoms, the diagnosis is supported with imaging highlighting Rigler’s triad. The therapeutic approach can be either endoscopic or surgical. Case Series: The authors present two cases of Bouveret’s syndrome, managed with two different approaches. The first case is an 82-year-old man presenting with diffuse abdominal pain and distension, nausea, and vomiting. Blood tests showed increased inflammatory parameters and an abdominal computed tomography (CT) scan compatible with Bouveret’s syndrome. Upper gastrointestinal (GI) endoscopy revealed a fistula at D2 level, and an obstruction at D3, caused by a 3 cm gallstone. The patient underwent laser and mechanical lithotripsy for gallstone removal. The second case is a 71-year-old woman presenting with vomiting associated with dehydration and abdominal pain for several days. Blood tests showed increased inflammatory parameters and CT scan showed a bilioduodenal fistula at D2 level, with a 5 cm a gallstone at that level, confirmed in the endoscopy. An attempt to remove the gallstone was performed, without success, so the patient underwent laparotomy with extraction of the gallstone via an anterior gastrotomy. Conclusion: Bouveret’s syndrome is a rare disease that requires thoughtful and tailored management. Given this rarity, there is minimal data to support specific therapy recommendations. Therefore, management should be tailored to the patient at the discretion of the multidisciplinary team and the resources of the institution.

show abstract

Endoscopic and surgical management of Bouveret’s syndrome complicated by gallstone ileus

Cited by 4 publications

References 9 publications

Synchronous Gallstone Ileus and Bouveret’s Syndrome: A Report of Two Rare Concurrent Complications of Gallstone Disease

Synchronous Gallstone Ileus and Bouveret’s Syndrome: A Report of Two Rare Concurrent Complications of Gallstone Disease

A Case of Bouveret’s Syndrome Treated With Holmium:Yttrium-Aluminum-Garnet Laser

Endoscopic versus surgical management in Bouveret’s syndrome: A case series

Contact Info

Product

Resources

About