Endoscopically assisted minimally invasive surgery for gallstones

Abstract

This is a case of an 85-year-old female patient who presented with a 1-week history of nausea, intermittent bilious vomiting and anorexia. Imaging confirmed the diagnosis of Bouveret syndrome caused by two large gallstones. Conventional endoscopic methods successfully extracted the impacted stones from the duodenum into the stomach but were unable to extract the stones from the stomach. A mini-transverse laparotomy and gastrotomy were performed to finally extract the stones.

Bouveret Syndrome—The Rarest Variant of Gallstone Ileus: A Case Report and Literature Review

“…It is estimated that gallstone ileus occurs in 0.3–0.4% of all patients with cholelithiasis and it is seven times more frequent in patients aged over 70 [1]. The term classic or typical gallstone ileus usually refers to the obstruction of the terminal ileum from a calculus [1, 6, 7]. That is the most common location of the obstructing gallstone accounting for 50–90% of all cases [1, 2, 4].…”

“…Bouveret syndrome is extremely rare and most commonly affects elderly women with a mean age of 68.6 years [1, 2, 6, 7]. More than 60% of the reported cases have an associated previous clinical history [1] while the majority of patients have known biliary lithiasis [2].…”

“…It has been reported that 43–68% of patients have a history of recent biliary colic bouts, jaundice or acute cholecystitis, but the first manifestation of cholelithiasis as Bouveret syndrome is possible as well [1]. Nausea, vomiting and abdominal pain in the epigastrium and right hypochondrium are frequent [2, 6, 7], but their intensity often does not correlate with the underlying anatomic alterations [1]. Fever, signs of dehydration and weight loss can be present as well [2].…”

“…Sepsis is an unusual manifestation [1]. Less frequently, Bouveret syndrome may present with haematemesis [1, 5–7] secondary to duodenal [1, 6] or celiac artery erosions [6]. The expulsion of a stone during vomiting or the presence of oesophageal lesions due to intense vomiting are also possible [1].…”

“…Morbidity and mortality rates have decreased in recent years but still remain high, estimated at 60% and 12%–30% respectively, due to the advanced age and the comorbid factors of the patients [4–7]. These rates strictly depend on the therapeutic approach [4].…”