Gastroenterologie
a hepatologie

Endoscopic treatment of Bouveret syndrome

Nageeb Ghaleb¹, Petr Fojtík ^{Orcid.org  2}

+ Affiliation
¹ Centrum péče o zažívací trakt, Vítkovická nemocnice, a. s., Ostrava
² Centrum péče o zažívací trakt, Vítkovická nemocnice a. s., Ostrava

Summary

Bouveret syndrome is a rare complication of cholecystolithiasis in which a gallstone travels into the duodenum via a cholecystogastric or cholecystoduodenal fistula, leading to decreased digestive propulsion and symptoms of gastric outlet obstruction. In this case report, we describe successful endoscopic treatment of Bouveret syndrome in an elderly male patient without serious ailments. The personal history of the patient revealed he had experienced one attack of biliary colic, without any mention of dyspeptic symptoms. The patient began to suffer from recurrent vomiting after a dietary mistake following his admittance to a long-term geriatric ward in order to treat his repetitive attacks of gout. After surgical examination, the patient underwent a series of imaging analyses. An abdominal X-ray did not show any sign of ileus and an abdominal ultrasound scan did not visualise the gallbladder; however, gastric distension was detected. Therefore, we performed an endoscopy to examine the stomach. A large impacted gallstone was found in the region of the duodenal bulb. It was not possible to extract the entire gallstone via the oesophagus because part of it was stenotic; therefore, mechanical lithotripsy was performed. The crushed gallstone were left in the gastrointestinal tract. A follow-up ultrasound scan visualised the gallbladder filled with stones; however, surgery was not performed. Bouveret syndrome is more frequent in elderly patients with multiple diseases and is therefore associated with a high mortality rate. Attempts should be made to retrieve gallstones via endoscopy, even though the success rate is variable. Surgical procedures, such as enterotomy, duodenotomy and gastrotomy, should only be performed after endoscopic retrieval has failed.

Keywords

Bouveret syndrome, gastroscopy, lithotripsy, gastric outlet obstruction, gallstone ileus

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