Bouveret’s Syndrome Resulting in Gallstone Ileus

Excerpt

An 82-year-old female presented with 6 days of worsening nausea, abdominal pain, and one episode of coffee ground emesis. CT scan revealed gastric outlet obstruction secondary to a 3.6 × 3.3 cm gallstone seen within the second portion of the duodenum (Fig. 1). An endoscopic retrograde cholangiopancreatography (ERCP) confirmed the presence of a 4-cm obstructing, pigmented gallstone in the second portion of the duodenum. Electrohydraulic lithotripsy (EHL) and subsequent mechanical lithotripsy were used to fragment the obstructing stone. The largest stone fragment was withdrawn into the stomach; it could not be fully retrieved but was felt small enough to allow spontaneous passage through the GI tract. Ampullary sphincterotomy was also performed and multiple, smaller gallstones were removed from the common bile duct. No cholecystoenteric fistula was identified, and a plastic stent was placed. Following the procedure, the patient tolerated a diet and was discharged symptom-free.

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