A Rare Cause of Gastroduodenal Obstruction

Abstract

Methods: Case Report An 85-year-old female with history of hypertension was admitted to the hospital with a three day history of nausea and vomiting. An abdominal CT was performed and revealed a large calcified mass (Fig. 1) and pneumobilia. A large obstructing duodenal gallstone (Fig. 1) located in the third portion was found on upper endoscopy. Attempts to remove the object endoscopically were unsuccessful. An apparent fistula was found in the duodenal bulb. An enterolithotomy was performed where a 5 cm gallstone was extracted and she did well post-operatively.FigureConclusion: Discussion Bouveret's syndrome is characterized by gastroduodenal obstruction secondary to an impacted duodenal or pyloric channel gallstone via a cholecysto-duodenal or cholecysto-gastric fistula. Clinically patients present with symptoms of obstruction and radiographic studies reveal pneumobilia, cholelithiasis, and a distended stomach. Endoscopic findings include retained food, an impacted stone, and occasionally a fistula which was seen in our patient. Treatment is usually surgery, consisting of an enterolithotomy with or without concomitant cholecystectomy and fistula repair. Recently there have been reports of endoscopic therapy disintegrating gallstones including intracorporal laser lithotripsy, endoscopic mechanical lithotripsy, and electrohydraulic lithotripsy (1). Reference: 1. Gemmel G, Weickert U, Eickhoff A, et al. Successful treatment of gallstone ileus (Bouveret syndrome) by using extracorporal shock wave lithotripsy and plasm coagulation. Gastrointest Endosc 2007;65:173–175.