Laparoscopic treatment of an upper gastrointestinal obstruction due to Bouveret’s syndrome

Abstract

Bouveret’s syndrome is an extremely rare type of gallstone-induced ileus with atypical clinical manifestations, such as abdominal distension and pain, nausea and vomiting, fever or even gastrointestinal bleeding, which may easily be misdiagnosed. In the present case, a 55-year-old male was admitted to the hospital with upper gastrointestinal obstructive symptoms but without pain, fever, jaundice or melena. At first, gastrolithiasis and peptic ulcer combined with pyloric obstruction were suspected after gastroscopy revealed a large, hard stone in the duodenal bulb. A revised diagnosis of Bouveret’s syndrome was made following abdominal computed tomography. Subsequently, the patient exhibited a good postoperative recovery after laparoscopic duodenotomy for gallstone removal and subtotal cholecystectomy. The condition of the patient remained stable after being followed up for 6 mo. The successful application of laparoscopic therapy to treat Bouveret’s syndrome has seldom been reported. Laparoscopic enterolithotomy is safe and effective, with good patient tolerability, rapid postoperative recovery and few wound-related complications. The laparoscopic treatment of Bouveret’s syndrome is worth exploring.

Keywords: Bouveret’s syndrome, Gallstone, Gastric outlet obstruction, Laparoscopic therapy, Cholecystoenteric fistula

Core tip: Bouveret’s syndrome is a rare cause of gastric outflow obstruction and is easily misdiagnosed. In this case, the patient was middle-aged and did not present any chronic systemic disease. The clinical symptoms were atypical, with neither infection nor abdominal pain. The onset suggested peptic ulcer and pyloric obstruction, which was initially suspected as gastrolithiasis. An imaging study from a year prior provided important data regarding the evolution and diagnosis of the disease. The successful application of laparoscopic therapy to treat Bouveret’s syndrome has seldom been reported. This patient obtained satisfactory results after laparoscopic duodenotomy for gallstone removal and subtotal cholecystectomy.