Endoscopic Removal of Gallstone Through Choledochoduodenal Fistula

Abstract

Introduction: We present a 91-year-old female presenting with abdominal pain and found to have a large gallstone and choledochoduodenal fistula successfully treated with endoscopy. She presented with a 1-week history of nonspecific abdominal pain, bloating, constipation, and nonbilious vomiting. Two weeks prior to her admission, she had an episode of small bowel obstruction from gallstone treated by exploratory laparotomy with stone removal from terminal ileum. On examination she was afebrile and anicteric. Abdomen was soft, nontender with hypoactive bowel sounds. Right upper quadrant ultrasound revealed a large 3.7-cm stone in the gallbladder fundus and possible cholecystoduodenal fistula. Upper endoscopy showed a cholecystoduodenal fistula in the duodenal bulb and a large impacted stone (Figure 1) in the gallbladder fundus. Subsequently, the gallstone was disimpacted from gallbladder fundus (Figure 2) using multiple endoscopic accessories. Roth net was used to remove the intact stone per orum. There was mild gallbladder mucosal edema without any stone remnants (Figure 3) at the conclusion of the procedure. Her symptoms improved after the endoscopy and she was discharged home 2 days later. Bouveret syndrome refers to a gastric outlet obstruction secondary to impaction of a gallstone in the pylorus or proximal duodenum.Figure 1Figure 2Figure 3