Bouveret's Syndrome: Case Report and Review of the Literature

Iliana Doycheva,Amitabh Suman,Alpna Limaye,Shahnaz Sultan,Christopher E Forsmark

doi:10.1155/2009/914951

Iliana Doycheva, Amitabh Suman + Show 3 more

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https://doi.org/10.1155/2009/914951

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Abstract

Bouveret's syndrome is defined as gastric outlet obstruction caused by duodenal impaction of a large gallstone which passes into the duodenal bulb through a cholecystogastric or cholecystoduodenal fistula. Initial attempts at endoscopic retrieval with or without mechanical or extracorporeal lithotripsy should be performed as first-line treatment, though success rates with endoscopic treatment are variable. We describe a case of Bouveret's Syndrome in an elderly patient that was successfully treated with endoscopic extraction combined with mechanical lithotripsy, and review the literature on this uncommon condition.

Highlights

The first published report of Bouveret’s syndrome (1896) is attributed to Leon Bouveret who reported on two patients with this disease [1]
The patient was brought back the following day for attempted stone extraction, at which time the stone was successfully removed from the duodenum and transferred to the stomach using various devices including a retrieval net, snare, stone extracting basket, and lithotripsy basket
Fistula formation is thought to occur as a result of adhesions between the gallbladder and the bowel wall from chronic inflammation, impaired arterial blood supply and decreased venous drainage [6]

Summary

Introduction

The first published report of Bouveret’s syndrome (1896) is attributed to Leon Bouveret who reported on two patients with this disease [1]. There have been several case reports of unique manifestations of Bouveret’s syndrome, as well as reports of novel endoscopic treatment modalities. Bouveret’s syndrome tends to occur more commonly in women (65%) with a median age of 74.1 years at presentation [2]. Because it often presents in patients with advanced age and multiple comorbidities, it is associated with a high rate of mortality. Endoscopic treatment should always be attempted in order to avoid surgery in these patients. For patients in whom endoscopic extraction has failed, simple enterolithotomy, duodenotomy or gastrotomy, and stone extraction can be performed [3]

Case Presentation

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