Successful endoscopic therapy of a gastric outlet obstruction due to a gallstone with intracorporeal laser lithotripsy: a case of Bouveret’s syndrome

Abstract

Bouveret’s syndrome is a rare clinical condition characterized by a gastric outlet obstruction due to a gallstone. It occurs predominantly in elderly women. 1 Frattaroli FM Reggio D Guadalaxara A Illomei G Lomanto D Pappalardo G. Bouveret’s syndrome: case report and review of the literature. Hepatogastroenterology. 1997; 44: 1019-1022 PubMed Google Scholar Most commonly the gallstone migrates through a spontaneous cholecystoduodenal fistula into the intestine. 2 Heinrich D Meier J Wehrli H Bühler H. Upper gastrointestinal hemorrhage preceding development of Bouveret's syndrome. Am J Gastroenterol. 1993; 5: 777-780 Google Scholar , 3 LeBlanc KA Barr LH Rush MB. Spontaneous biliary enteric fistulas. South Med J. 1983; 76: 1249-1252 Crossref PubMed Scopus (33) Google Scholar , 4 Simonian SJ. Gallstone obstruction of the duodenal bulb. Lancet. 1968; 1: 893-894 Abstract PubMed Google Scholar About 240 cases of Bouveret’s syndrome have been reported worldwide. 1 Frattaroli FM Reggio D Guadalaxara A Illomei G Lomanto D Pappalardo G. Bouveret’s syndrome: case report and review of the literature. Hepatogastroenterology. 1997; 44: 1019-1022 PubMed Google Scholar It is mainly treated by surgery 1 Frattaroli FM Reggio D Guadalaxara A Illomei G Lomanto D Pappalardo G. Bouveret’s syndrome: case report and review of the literature. Hepatogastroenterology. 1997; 44: 1019-1022 PubMed Google Scholar and only few reports of successful endoscopic therapy with mechanical and electrohydraulic lithotripsy 5 Bedogni G Contini S Meinero M Pedrazzoli C Piccinini GC. Pyloroduodenal obstruction due to a biliary stone (Bouveret's syndrome) managed by endoscopic extraction. Gastrointest Endosc. 1985; 31: 36-38 Abstract Full Text PDF PubMed Scopus (56) Google Scholar , 6 Moriai T Hasegawa T Fuzita M Kimura A Tani T Makino I. Successful removal of massive intragastric gallstones by endoscopic electrohydraulic lithotripsy and mechanical lithotripsy. Am J Gastroenterol. 1991; 86: 627-629 PubMed Google Scholar , 7 Fujita N Noda Y Kobayashi G Kimura K Watanabe H Shirane A et al. Gallstone ileus treated by electrohydraulic lithotripsy. Gastrointest Endosc. 1992; 38: 617-619 Abstract Full Text PDF PubMed Scopus (21) Google Scholar , 8 Lopez-Roses L Toscano J Iniguez F Santos E Perez Carnero A. Terapeutica endoscopica eficaz en un caso de sindrome de Bouveret. Rev Esp Enferm Dig. 1994; 85: 483-485 PubMed Google Scholar , 9 Dumonceau JM Delhaye M Devière J Baize M Cremer M. Endoscopic treatment of gastric outlet obstruction caused by a gallstone (Bouveret’s syndrome) after extracorporeal shock-wave lithotripsy. Endoscopy. 1997; 29: 319-321 Crossref PubMed Scopus (42) Google Scholar or extracorporeal shock wave lithotripsy (ESWL) 10 Holl J Sackmann M Hoffmann R Schüssler P Sauerbruch T Jüngst D Paumgartner G. Shock-wave therapy of gastric outlet syndrome caused by a gallstone. Gastroenterology. 1989; 97: 472-474 PubMed Google Scholar have been published. To our knowledge this is the first report of gastric outlet obstruction caused by a gallstone that was treated successfully by means of fluoroscopically guided intracorporeal laser lithotripsy (ILL) alone.