Concomitant Bouveret's syndrome and biliary obstruction: A tailored treatment approach for an elderly patient.

Abstract

Introduction and importanceBouveret's syndrome is a very rare form of gallstone ileus, that occurs when a sizable gallstone enters the gastrointestinal tract via a bilioenteric fistula and is impacted in the pylorus or proximal duodenum, causing gastric outlet obstruction. It usually occurs in a geriatric population with multiple comorbidities, and causes significant morbidities and mortalities.Case presentationAn 88-year-old patient with concomitant Bouveret's syndrome and biliary obstruction was presented. The duodenal obstructed stone and biliary stone were successfully removed by endoscopic approach. The patient resumed diet on day-1 and recovered smoothly.Clinical discussionDue to the rarity of Bouveret's syndrome, there are no standardized recommendations for the management of these patients, including open, laparoscopic surgical approach or endoscopic approach. Minimally invasive treatment was tailored to the condition of the patient and clinical findings.ConclusionThe best approach is the one tailored to each patient, with the consideration of the patient's medical condition, age, comorbidities, life expectancy, and available expertise. This article highlights the key features of the disease, and the precautions during endoscopic treatment.