Published online May 21, 2020. doi: 10.3748/wjg.v26.i19.2458
Peer-review started: November 21, 2019
First decision: January 7, 2020
Revised: April 3, 2020
Accepted: April 27, 2020
Article in press: April 27, 2020
Published online: May 21, 2020
Bouveret´s syndrome is defined as a gastric outlet obstruction after passage of a gallstone through a fistula into the duodenum. Due to its rarity, the diagnosis of Bouveret’s syndrome is often delayed and causes a high morbidity and mortality rate.
A 93-year-old female presented with worsening pain in the right upper abdomen and vomiting. A gastroscopy revealed fluid retention caused by a massive obstructive stone in the bulbus. Endoscopic laser lithotripsy of the impacted stone was planned after multidisciplinary consultation. A Dornier Medilas H Solvo lithotripsy 350 µm laser fiber (10 Hz, 2 Joules) was used to disintegrate the stone into smaller pieces. The patient recovered completely.
A mechanical obstruction due to a gallstone that has entered the gastrointestinal tract is a complication that appears in 0.3%-0.5% of patients who have cholelithiasis. Stones larger than 2 cm can become impacted in the digestive tract, which occurs mostly in the terminal ileum. In approximately 1%-3% of cases, the stones cause obstruction in the duodenum. This phenomenon is called Bouveret’s syndrome. As this condition is mostly observed in elderly individuals with multiple comorbidities, treatment by an open surgical approach is unsuitable. Endoscopic removal is the preferred technique. The benefit of using laser lithotripsy is the precise targeting of energy onto the stone with minimal tissue injury. Endoscopic laser lithotripsy is a safe and feasible treatment option for Bouveret’s syndrome.
Core tip: We report a patient with Bouveret’s syndrome, a rare disease with high morbidity and mortality due to delayed diagnosis. We succeeded in removing the gallstone using endoscopic laser lithotripsy and the patient recovered completely. This treatment is preferred due to the precise targeting of energy with minimal tissue injury.