Arthur Berg, DO, Joshua Klein, DO, Steven Shikiar, MD, Maurizio Miglietta, DO. Hackensack UMC Palisades
Introduction: Bouveret’s Syndrome is a rare form of gallstone ileus in which an impaction of a gallstone in the duodenum results in a gastric outlet obstruction. Gallstone ileus accounts for approximately 2-3% of all cases of small bowel obstruction. The terminal ileum is the most common location for a calculus to cause obstruction followed by the proximal ileum, jejunum and duodenum/stomach respectively. Open and laparoscopic surgery has previously been the mainstay of treatment for Bouveret’s Syndrome, however with the advent of new endoscopic techniques and instruments there has been increasing success in endoscopic management. This case report looks at a patient with a gastric outlet obstruction from a gallstone, and discusses the current literature regarding diagnosis and management.
Case: 69 year old male presented with several day history of epigastric abdominal pain and multiple episodes of nonbloody, nonbilious emesis. He had previously been diagnosed with cholelithiasis, however had refused surgery at that time. On admission the patient was found to have a leukocytosis of 13.5. An ultrasound was performed in which the images were limited due to pneumobilia. A subsequent CT scan revealed pneumobilia, and a large 2cm gallstone impacted in the first portion of the duodenum causing a gastric outlet obstruction. The patient underwent failed endoscopic attempts at removal and ultimately required a laparotomy, enerotomy with stone extraction.
Discussion: Bouveret’s syndrome is a rare variant of gallstone ileus. With newer endoscopic techniques and electrohydraulic lithotripsy, there has been increasing success with endoscopic retrieval of the impacted gallstones. There is some controversy in regards to the need for definitive operative management. Stone extraction, without cholecystectomy and fistula repair, has been shown to have less postoperative complications as well as lower mortality rates compared to when a cholecystectomy and fistula repair has been performed.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86485
Program Number: P191
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster