• Skip to primary navigation
  • Skip to main content
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • SAGES Store
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
    • “Unofficial” Logo Products
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2024 Scientific Session Call For Abstracts
      • 2024 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Fellows Career Development Course
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • OWLS
  • Log In

Bouveret’s Syndrome: Gallstone Ileus of the Duodenum

Introduction: This is a case of a 59 year old female with Bouveret’s syndrome. An initial endoscopic approach to management is described. Gallstone ileus occurs when a gallstone passes from a cholecystoduodenal fistula or a choledochoduodenal fistula into the GI tract and causes obstruction, usually at the ileocecal valve. Bouveret’s syndrome is a variant of gallstone ileus where the gallstone lodges in the duodenum or pylorus causing a gastric outlet obstruction.

Case: The patient presented to the emergency department with a 3-day history of nausea and vomiting. Liver function tests were normal, but a CT revealed pneumobilia with evidence of cholecystitis and cholecystoduodenal fistula. There was a large obstructing gallstone in the 3rd portion of the duodenum. An unsuccessful attempt was made at endoscopic retrieval using multiple modalities including net, snare, stone basket, balloons, and biopsy forceps. Combination modalitiesincluding a dual channel scope with two balloons and another attempt using a snarewith rat-tooth forceps for manipulation and stabilization of the stone were also unsuccessful. The smooth, calcified exterior surface would not allow purchase of the jaws of the forceps.The length of the stone prohibited passage of guidewires and balloons alongside the duodenum. She then underwent a one-stage procedure including enterolithotomy and cholecystectomy with repair of the cholecystoduodenal fistula. The stone at laparotomy had migrated approximately 30cm into the jejunum and was removed via an enterotomy. The gallbladder was removed and the fistula repair buttressed with an omental patch and fibrin glue. The gallstone was measured at 8×4 cm. The patient has done well in the post-operative period.

Discussion: Gallstone ileus is a rare complication of cholelithiasis. Bouveret’s syndrome is a rare variant, accounting for 1-3% of cases of gallstone ileus. It is diagnosed radiographically via CT scan. There is some controversy regarding the operative treatment of Bouveret’s syndrome. The primary goal of therapy is to relieve the obstruction by removing the stone. If the patient will tolerate it, the gallbladder should be removed and the fistula repaired. Newer techniques involving endoscopic retrieval and electrohydraulic lithotripsy (EHL) should also be considered; but this will depend on the stability of the patient and the available equipment and expertise of the team caring for the patient. There is no documented endoscopic experience using EHL in the duodenum and risk of perforation is a consideration. Additionally, large fragments of the stone could have resulted in distal obstruction. The stone in this case was too large for any of our available endoscopic modalities. Given the concern for perforation due to pressure necrosis, she was taken to the operating room for definitive management.

Conclusion: Bouveret’s syndrome is an uncommon variation of a rare disease. The endoscopic and surgical management of this processare important to keep in mind and may be evolving as endoscopic therapies improve.


Session: Poster

Program Number: P400

View Poster

4,654

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

Hours & Info

11300 West Olympic Blvd, Suite 600
Los Angeles, CA 90064
1-310-437-0544
[email protected]
Monday - Friday
8am to 5pm Pacific Time

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons