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Successful Multimodality Endoscopic Treatment of Gastric Outlet Obstruction Caused by an Impacted Gallstone (Bouveret's Syndrome).

Rogart JN, Perkal M, Nagar A - Diagn Ther Endosc (2008)

Bottom Line: Due to the large size of these stones and the difficult location in which they become impacted, endoscopic treatment is unsuccessful and most patients require surgery.After several endoscopic sessions and the use of multiple instruments including a Holmium: YAG laser and electrohydraulic lithotripter, fragmentation and endoscopic removal of the stone were successful.We describe the difficulties encountered which necessitated varied and innovative therapeutic techniques.

View Article: PubMed Central - PubMed

Affiliation: Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, West Haven VAMC, CT 06510, USA.

ABSTRACT
Bouveret's syndrome is a rare condition of gastric outlet obstruction resulting from the migration of a gallstone through a choledochoduodenal fistula. Due to the large size of these stones and the difficult location in which they become impacted, endoscopic treatment is unsuccessful and most patients require surgery. We report the case of an elderly male who presented with nausea and hematemesis, and was found on CT scan and endoscopy to have an obstructing gallstone in his duodenal bulb. After several endoscopic sessions and the use of multiple instruments including a Holmium: YAG laser and electrohydraulic lithotripter, fragmentation and endoscopic removal of the stone were successful. We believe this to be the first case of Bouveret's syndrome successfully treated by endoscopy alone in the United States. We describe the difficulties encountered which necessitated varied and innovative therapeutic techniques.

No MeSH data available.


Related in: MedlinePlus

Computed tomography (CT) scan of abdomen and pelvis. (a) Axial image showing pneumobilia (arrow) and a dilated fluid-filled stomach (). (b) 1-2 large gallstones (arrow) can be seen within an area of inflammationwhere the gallbladder is in close proximity to the duodenum. (c) Coronal reconstruction showing gallstone within duodenum (long arrow), Pneumobilia (short arrows), and dilated stomach () are also seen.
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fig1: Computed tomography (CT) scan of abdomen and pelvis. (a) Axial image showing pneumobilia (arrow) and a dilated fluid-filled stomach (). (b) 1-2 large gallstones (arrow) can be seen within an area of inflammationwhere the gallbladder is in close proximity to the duodenum. (c) Coronal reconstruction showing gallstone within duodenum (long arrow), Pneumobilia (short arrows), and dilated stomach () are also seen.

Mentions: An 85-year-old male with advancedAlzheimer's dementia, diabetes mellitus, and atrial fibrillation presented withseveral days of nausea, vomiting, and lethargy. There was no report ofabdominal pain, fever, or chills. Hisvital signs were stable and his abdominal exam benign. Nasogastric lavage was significant for one literof coffee-ground material. His laboratoryexamination demonstrated a white blood cellcount of 25 000/cm2, Hematocrit of 33%, creatinine of 1.5 mg/dL, and normal liver enzymes. A CT scan (seeFigure 1) showed a markedly distended stomach, air in the biliary tree, and a thickenedgallbladder containing one or two large gallstones, the largest  cm insize, which appeared to be abutting the duodenal wall in an area of significantinflammation.


Successful Multimodality Endoscopic Treatment of Gastric Outlet Obstruction Caused by an Impacted Gallstone (Bouveret's Syndrome).

Rogart JN, Perkal M, Nagar A - Diagn Ther Endosc (2008)

Computed tomography (CT) scan of abdomen and pelvis. (a) Axial image showing pneumobilia (arrow) and a dilated fluid-filled stomach (). (b) 1-2 large gallstones (arrow) can be seen within an area of inflammationwhere the gallbladder is in close proximity to the duodenum. (c) Coronal reconstruction showing gallstone within duodenum (long arrow), Pneumobilia (short arrows), and dilated stomach () are also seen.
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC2239211&req=5

fig1: Computed tomography (CT) scan of abdomen and pelvis. (a) Axial image showing pneumobilia (arrow) and a dilated fluid-filled stomach (). (b) 1-2 large gallstones (arrow) can be seen within an area of inflammationwhere the gallbladder is in close proximity to the duodenum. (c) Coronal reconstruction showing gallstone within duodenum (long arrow), Pneumobilia (short arrows), and dilated stomach () are also seen.
Mentions: An 85-year-old male with advancedAlzheimer's dementia, diabetes mellitus, and atrial fibrillation presented withseveral days of nausea, vomiting, and lethargy. There was no report ofabdominal pain, fever, or chills. Hisvital signs were stable and his abdominal exam benign. Nasogastric lavage was significant for one literof coffee-ground material. His laboratoryexamination demonstrated a white blood cellcount of 25 000/cm2, Hematocrit of 33%, creatinine of 1.5 mg/dL, and normal liver enzymes. A CT scan (seeFigure 1) showed a markedly distended stomach, air in the biliary tree, and a thickenedgallbladder containing one or two large gallstones, the largest  cm insize, which appeared to be abutting the duodenal wall in an area of significantinflammation.

Bottom Line: Due to the large size of these stones and the difficult location in which they become impacted, endoscopic treatment is unsuccessful and most patients require surgery.After several endoscopic sessions and the use of multiple instruments including a Holmium: YAG laser and electrohydraulic lithotripter, fragmentation and endoscopic removal of the stone were successful.We describe the difficulties encountered which necessitated varied and innovative therapeutic techniques.

View Article: PubMed Central - PubMed

Affiliation: Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, West Haven VAMC, CT 06510, USA.

ABSTRACT
Bouveret's syndrome is a rare condition of gastric outlet obstruction resulting from the migration of a gallstone through a choledochoduodenal fistula. Due to the large size of these stones and the difficult location in which they become impacted, endoscopic treatment is unsuccessful and most patients require surgery. We report the case of an elderly male who presented with nausea and hematemesis, and was found on CT scan and endoscopy to have an obstructing gallstone in his duodenal bulb. After several endoscopic sessions and the use of multiple instruments including a Holmium: YAG laser and electrohydraulic lithotripter, fragmentation and endoscopic removal of the stone were successful. We believe this to be the first case of Bouveret's syndrome successfully treated by endoscopy alone in the United States. We describe the difficulties encountered which necessitated varied and innovative therapeutic techniques.

No MeSH data available.


Related in: MedlinePlus