Laser lithotripsy resolution for Bouveret syndrome

Abstract

A 75-year-old woman was admitted with epigastric pain, nausea, and vomiting, but without any other symptoms. Laboratory testing and physical examination were normal. Her abdominal computed tomography (CT) scan on admission identified a cholecystoenteric fistula (duodenum to distal antrum) with a 4-cm stone in the duodenum, all of which was compatible with Bouveret syndrome (▶ Fig. 1) We performed a gastroscopy, which identified pyloric obstruction due to a huge stone that was preventing advancement of the endoscope (▶ Fig. 2 a).

Bouveret syndrome: current management strategies

“…One of the most promising techniques for fragmenting stones is laser lithotripsy. 10 Multiple techniques of laser lithotripsy have been utilized, including neodymium: YAG, 11 rhodamine, 12 and holmium: YAG. 10 The benefit of using laser lithotripsy is precise targeting of energy onto the stone with minimal tissue injury.…”

“… 10 Multiple techniques of laser lithotripsy have been utilized, including neodymium: YAG, 11 rhodamine, 12 and holmium: YAG. 10 The benefit of using laser lithotripsy is precise targeting of energy onto the stone with minimal tissue injury. Some lithotripters have an additional capability of differentiating stone from tissue and interrupting signals that may potentially cause tissue damage.…”

Bouveret’s syndrome: A case based review; clinical presentation, diagnostics and treatment approaches

“…The advantage of laser using is splitting the stone with minimal tissue damage. [22,23] Holmium: YAG laser fragmentation has benefits over neodymium and rhodamine laser given the capability of applying high energy via flexible and small probes. [24] Holl et al first reported the success of extracorporeal shockwave lithotripsy in gallstone impacted in duodenum.…”