Laparoscopic treatment of an upper gastrointestinal obstruction due to Bouveret’s syndrome

Abstract

Bouveret's syndrome is an extremely rare type of gallstone-induced ileus with atypical clinical manifestations, such as abdominal distension and pain, nausea and vomiting, fever or even gastrointestinal bleeding, which may easily be misdiagnosed. In the present case, a 55-year-old male was admitted to the hospital with upper gastrointestinal obstructive symptoms but without pain, fever, jaundice or melena. At first, gastrolithiasis and peptic ulcer combined with pyloric obstruction were suspected after gastroscopy revealed a large, hard stone in the duodenal bulb. A revised diagnosis of Bouveret's syndrome was made following abdominal computed tomography. Subsequently, the patient exhibited a good postoperative recovery after laparoscopic duodenotomy for gallstone removal and subtotal cholecystectomy. The condition of the patient remained stable after being followed up for 6 mo. The successful application of laparoscopic therapy to treat Bouveret's syndrome has seldom been reported. Laparoscopic enterolithotomy is safe and effective, with good patient tolerability, rapid postoperative recovery and few wound-related complications. The laparoscopic treatment of Bouveret's syndrome is worth exploring.

Bouveret syndrome: current management strategies

“…In the failure of or lack of availability of endoscopic therapies, the minimally invasive laparoscopic approach to treatment should be considered as the preferred treatment in patients with Bouveret syndrome if equipment and expertise is available. 34 , 35 …”

Choledochoduodenal fistula in Mainland China: a review of epidemiology, etiology, diagnosis and management

“…There are some signs related to these diseases. The presence of an internal biliary fistula was suggested in some cases by the findings of pneumobilia, atrophic gallbladder, and biliary stones [ 65 ]. Furthermore, the bile sample collected from the CBD showed high levels of pancreatic enzymes, including amylase and phospholipase-A2 [ 66 ].…”

Laparoscopic management of Bouveret syndrome

“…The successful laparoscopic removal of 4 and 5 cm duodenal gallstones has recently been described 9 10. If feasible, a minimally invasive approach is logical; the patients are frequently elderly and unfit, the mortality from gallstone ileus has been quoted at 30%11 and a laparotomy is often a big insult.…”