Migrating Intrathoracic Gallstone

Abstract

We present the case of a 76-year-old man referred to our hospital with a round stone in central mediastinum and pneumomediastinum in chest radiography and computed tomography. He had a previous history of attempt of endoscopic retrievement of a gallstone that had caused a gastric outlet obstruction (Bouveret syndrome). To our knowledge, this is the first imaging description of mediastinal gallstone caused by esophagus perforation during complicated endoscopic lithotomy.

Bouveret Syndrome: When a Stone Cannot Pass the Pylorus

“…6,7 The proximal jejunum and ileum are less common sites (20%–40%), and the colon, stomach, and duodenum are even less common (<5%). 5,8 At least 0.3%–0.5% of patients with gallstones develop ileus. 5 Morbidity and mortality are high at 15%–33%.…”

“…9 Factors that lean toward fistula formation include, but are not limited to, large gallstones, extensive history of biliary disease, recurrent episodes of cholecystitis, female sex, age older than 60 years, peptic ulcer, and tumors. 5,8,10…”

“…5,8,9,11 Endoscopic treatment can cause complications such as migration of the gallstone to the intrathoracic cavity via an esophageal tear if patients have concomitant esophagitis or if the gallstone is large in size. 8 Surgical methods including enterolithotomy, which is associated with less morbidity, and duodenotomy, occasionally followed by cholecystectomy and fistula repair, are performed when endoscopic approaches are partially or completely unsuccessful. 5,8,9,11…”

“…8 Surgical methods including enterolithotomy, which is associated with less morbidity, and duodenotomy, occasionally followed by cholecystectomy and fistula repair, are performed when endoscopic approaches are partially or completely unsuccessful. 5,8,9,11…”

Uncommon presentation of a common disease - Bouveret's syndrome: A case report and systematic literature review

“…In about one-third of cases the diagnosis can be made by a plain abdominal film that demonstrates the classical Rigler's triad of a dilated stomach, pneumobilia, and a radio-opaque shadow in the region of the duodenum representing the ectopic gallstone [47,[209][210][211][212][213] . There have been some reported cases of migrating stone into the mediastinum after relieving an obstructed duodenum of BS via endoscope [71] . Ultrasound can be helpful as indicated in some papers [184] , but the study can be greatly degraded by the presence of gas in the biliary tree.…”