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Case Reports
. 2002 Jun 18:2:15.
doi: 10.1186/1471-230x-2-15.

Bouveret's syndrome complicated by distal gallstone ileus after laser lithotropsy using Holmium: YAG laser

Mohammad M Alsolaiman  1 , Christoph Reitz, Ali T Nawras, John B Rodgers, Benedict J Maliakkal
Affiliations
Case Reports

Bouveret's syndrome complicated by distal gallstone ileus after laser lithotropsy using Holmium: YAG laser

Mohammad M Alsolaiman et al. BMC Gastroenterol. .

Abstract

Background: Bouveret's syndrome is an unusual presentation of duodenal obstruction caused by the passage of a large gallstone through a cholecystoduodenal fistula. Endoscopic therapy has been used as first-line treatment, especially in patients with high surgical risk.

Case presentation: We report a 67-year-old woman who underwent an endoscopic attempt to fragment and retrieve a duodenal stone using a Holmium: Yttrium-Aluminum-Garnet Laser (Ho:YAG) which resulted in small bowel obstruction. The patient successfully underwent enterolithotomy without cholecystectomy or closure of the fistula.

Conclusion: We conclude that, distal gallstone obstruction, due to migration of partially fragmented stones, can occur as a possible complication of laser lithotripsy treatment of Bouveret's syndrome and might require urgent enterolithotomy.

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Figures

Figure 1
Figure 1
Large obstructing gallstone just beyond the duodenal bulb with ulcerated duodenal wall.
Figure 2
Figure 2
4 cm mass within the duodenum (gallstone) and adjacent gallbladder with air fluid level.
Figure 3
Figure 3
Gallstone in the duodenum with holes and partial fragmentation after two sessions of laser lithotripsy.
Figure 4
Figure 4
Gallstone in the distal ileum with air in the center and partial destruction of the stone shell.
See this image and copyright information in PMC

References

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