Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2020; 26(19): 2458-2463
Published online May 21, 2020. doi: 10.3748/wjg.v26.i19.2458
Successful endoscopic treatment of a large impacted gallstone in the duodenum using laser lithotripsy, Bouveret’s syndrome: A case report
Sofie Hendriks, Mareille Maria Verseveld, Egbert Roeland Boevé, Robert Roomer
Sofie Hendriks, Robert Roomer, Department of Gastroenterology, Franciscus Gasthuis & Vlietland, Rotterdam 3045 PM, Zuid-Holland, Netherlands
Mareille Maria Verseveld, Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam 3045 PM, Zuid-Holland, Netherlands
Egbert Roeland Boevé, Department of Urology, Franciscus Gasthuis & Vlietland, Rotterdam 3045 PM, Zuid-Holland, Netherlands
Author contributions: Hendriks S, Verseveld MM, Boevé ER and Roomer R designed and performed the research; Hendriks S, Verseveld MM and Roomer R wrote the paper.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors report no relationships that could be construed as a conflict of interest
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sofie Hendriks, MSc, Medical Assistant, Department of Gastroenterology, Franciscus Gasthuis & Vlietland, Kleiweg 500, Rotterdam 3045 PM, Zuid-Holland, Netherlands. zootje91@hotmail.com
Received: November 21, 2019
Peer-review started: November 21, 2019
First decision: January 7, 2020
Revised: April 3, 2020
Accepted: April 27, 2020
Article in press: April 27, 2020
Published online: May 21, 2020
Processing time: 182 Days and 0.1 Hours
Abstract
BACKGROUND

Bouveret´s syndrome is defined as a gastric outlet obstruction after passage of a gallstone through a fistula into the duodenum. Due to its rarity, the diagnosis of Bouveret’s syndrome is often delayed and causes a high morbidity and mortality rate.

CASE SUMMARY

A 93-year-old female presented with worsening pain in the right upper abdomen and vomiting. A gastroscopy revealed fluid retention caused by a massive obstructive stone in the bulbus. Endoscopic laser lithotripsy of the impacted stone was planned after multidisciplinary consultation. A Dornier Medilas H Solvo lithotripsy 350 µm laser fiber (10 Hz, 2 Joules) was used to disintegrate the stone into smaller pieces. The patient recovered completely.

CONCLUSION

A mechanical obstruction due to a gallstone that has entered the gastrointestinal tract is a complication that appears in 0.3%-0.5% of patients who have cholelithiasis. Stones larger than 2 cm can become impacted in the digestive tract, which occurs mostly in the terminal ileum. In approximately 1%-3% of cases, the stones cause obstruction in the duodenum. This phenomenon is called Bouveret’s syndrome. As this condition is mostly observed in elderly individuals with multiple comorbidities, treatment by an open surgical approach is unsuitable. Endoscopic removal is the preferred technique. The benefit of using laser lithotripsy is the precise targeting of energy onto the stone with minimal tissue injury. Endoscopic laser lithotripsy is a safe and feasible treatment option for Bouveret’s syndrome.

Keywords: Bouveret’s syndrome; Laser lithotripsy; Endoscopy; Gallstone; Case report

Core tip: We report a patient with Bouveret’s syndrome, a rare disease with high morbidity and mortality due to delayed diagnosis. We succeeded in removing the gallstone using endoscopic laser lithotripsy and the patient recovered completely. This treatment is preferred due to the precise targeting of energy with minimal tissue injury.