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Bouveret's syndrome complicated by distal gallstone ileus after laser lithotropsy using Holmium: YAG laser.

Alsolaiman MM, Reitz C, Nawras AT, Rodgers JB, Maliakkal BJ - BMC Gastroenterol (2002)

Bottom Line: Bouveret's syndrome is an unusual presentation of duodenal obstruction caused by the passage of a large gallstone through a cholecystoduodenal fistula.The patient successfully underwent enterolithotomy without cholecystectomy or closure of the fistula.We conclude that, distal gallstone obstruction, due to migration of partially fragmented stones, can occur as a possible complication of laser lithotripsy treatment of Bouveret's syndrome and might require urgent enterolithotomy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Gastroenterology, Department of Medicine, Albany Medical College and VA Stratton Hospital, Albany, New York, USA.

ABSTRACT

Background: Bouveret's syndrome is an unusual presentation of duodenal obstruction caused by the passage of a large gallstone through a cholecystoduodenal fistula. Endoscopic therapy has been used as first-line treatment, especially in patients with high surgical risk.

Case presentation: We report a 67-year-old woman who underwent an endoscopic attempt to fragment and retrieve a duodenal stone using a Holmium: Yttrium-Aluminum-Garnet Laser (Ho:YAG) which resulted in small bowel obstruction. The patient successfully underwent enterolithotomy without cholecystectomy or closure of the fistula.

Conclusion: We conclude that, distal gallstone obstruction, due to migration of partially fragmented stones, can occur as a possible complication of laser lithotripsy treatment of Bouveret's syndrome and might require urgent enterolithotomy.

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Related in: MedlinePlus

Gallstone in the distal ileum with air in the center and partial destruction of the stone shell.
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Figure 4: Gallstone in the distal ileum with air in the center and partial destruction of the stone shell.

Mentions: A repeat computed tomography showed the gallstone in the distal ileum (Figure 4). The patient underwent surgery with an enterotomy, which revealed a 4.5×3.5×2.5 cm gallstone in the terminal ileum. The patient recovered well without repair of the cholecystoduodenal fistula and had no biliary problems at two years follow up.


Bouveret's syndrome complicated by distal gallstone ileus after laser lithotropsy using Holmium: YAG laser.

Alsolaiman MM, Reitz C, Nawras AT, Rodgers JB, Maliakkal BJ - BMC Gastroenterol (2002)

Gallstone in the distal ileum with air in the center and partial destruction of the stone shell.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC117132&req=5

Figure 4: Gallstone in the distal ileum with air in the center and partial destruction of the stone shell.
Mentions: A repeat computed tomography showed the gallstone in the distal ileum (Figure 4). The patient underwent surgery with an enterotomy, which revealed a 4.5×3.5×2.5 cm gallstone in the terminal ileum. The patient recovered well without repair of the cholecystoduodenal fistula and had no biliary problems at two years follow up.

Bottom Line: Bouveret's syndrome is an unusual presentation of duodenal obstruction caused by the passage of a large gallstone through a cholecystoduodenal fistula.The patient successfully underwent enterolithotomy without cholecystectomy or closure of the fistula.We conclude that, distal gallstone obstruction, due to migration of partially fragmented stones, can occur as a possible complication of laser lithotripsy treatment of Bouveret's syndrome and might require urgent enterolithotomy.

View Article: PubMed Central - HTML - PubMed

Affiliation: Division of Gastroenterology, Department of Medicine, Albany Medical College and VA Stratton Hospital, Albany, New York, USA.

ABSTRACT

Background: Bouveret's syndrome is an unusual presentation of duodenal obstruction caused by the passage of a large gallstone through a cholecystoduodenal fistula. Endoscopic therapy has been used as first-line treatment, especially in patients with high surgical risk.

Case presentation: We report a 67-year-old woman who underwent an endoscopic attempt to fragment and retrieve a duodenal stone using a Holmium: Yttrium-Aluminum-Garnet Laser (Ho:YAG) which resulted in small bowel obstruction. The patient successfully underwent enterolithotomy without cholecystectomy or closure of the fistula.

Conclusion: We conclude that, distal gallstone obstruction, due to migration of partially fragmented stones, can occur as a possible complication of laser lithotripsy treatment of Bouveret's syndrome and might require urgent enterolithotomy.

Show MeSH
Related in: MedlinePlus