Case Report
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World J Gastroenterol. Oct 28, 2013; 19(40): 6943-6946
Published online Oct 28, 2013. doi: 10.3748/wjg.v19.i40.6943
Laparoscopic treatment of an upper gastrointestinal obstruction due to Bouveret’s syndrome
Dong Yang, Zhen Wang, Zhi-Jun Duan, Shi Jin
Dong Yang, Zhi-Jun Duan, Department of Digestion, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
Zhen Wang, Department of Clinical Laboratory, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
Shi Jin, Department of Laparoscopic Surgery, The First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
Author contributions: Yang D and Wang Z contributed equally to this work; Yang D, Wang Z and Duan ZJ designed the report; Yang D and Duan ZJ served as attending doctors for the patient; Jin S performed the laparoscopic treatments; Yang D and Wang Z organized and wrote the paper.
Correspondence to: Zhi-Jun Duan, MD, Department of Digestion, The First Affiliated Hospital of Dalian Medical University, 222 Zhongshan Road, Dalian 116011, Liaoning Province, China. cathydoctor@yahoo.com
Telephone: +86-411-83635963 Fax: +86-411-82632383
Received: July 24, 2013
Revised: August 31, 2013
Accepted: September 15, 2013
Published online: October 28, 2013
Processing time: 111 Days and 10.6 Hours
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.