Post written by Ijlal Akbar Ali, MD, from the Department of Digestive Diseases and Nutrition, Oklahoma University Health Sciences Center, Oklahoma City, Oklahoma, USA.
We describe a case of a morbidly obese woman who presented to the emergency room with a 3-day history of right upper-quadrant abdominal pain. CT scan obtained demonstrated a 3-cm gallstone in the duodenum with a fistulous connection to the gall bladder. The patient underwent an upper endoscopy, and after initially being unsuccessful with pulling the stone through the pylorus, we were able to fracture the stone with the help of electrohydraulic lithotripsy and remove all stone pieces with the help of a snare. The patient did well post procedurally, and on post-discharge follow-up with surgery, it was decided to defer cholecystectomy and fistula repair and monitor for any recurrent symptoms owing to significant comorbidities.
Bouveret syndrome is a very rare form of gallstone ileus and open surgical therapy is associated with high morbidity and mortality. Previous reports suggest only 10% success rates with endoscopic approaches. However, this case serves as an example of the advancements made in the field of endoluminal lithotripsy and how a minimally invasive approach served this patient well.
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