P3742 - Bouveret Syndrome as a Cause of Gastric Outlet Obstruction: A Case Report

Santiago Garcia Ortiz, MD¹, Neha Khan, MD¹, Kayvon Sotoudeh, MD¹, Aida Rezaie, MD², Neil Vyas, MD¹, Savio Reddymasu, MD^1
1Creighton University, Phoenix, AZ; ²Creighton University, Mesa, AZ

Introduction: Bouveret syndrome is a rare complication of cholelithiasis. Delay in diagnosis is associated with a high mortality rate. It is a rare form of small bowel obstruction caused by a large biliary stone entering the lumen of the duodenum or the stomach through a bilioenteric fistula. Diagnosis is based upon clinical manifestations, endoscopy, and imaging studies such as abdominal computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP). Treatment options include various surgical techniques. However, recent advances in endoscopy also allow for non-surgical endoscopic treatment options.

Case Description/Methods: 79 year old male presented with recurrent abdominal pain for more than 6 weeks. A CT scan of the abdomen showed a partial gastric outlet obstruction caused by a 5.5 x 3.4 cm gallstone at the level of the pylorus. A fistulous communication was also noted between the pylorus and the gallbladder consistent with a cholecystogastric fistula. On upper endoscopy, a large 5 cm pigmented gallstone was visualized that occluded the duodenal bulb. The stone was fragmented over several endoscopic sessions with electrohydraulic lithotripsy (EHL) and eventually completed removed, revealing two cholecystoduodenal fistulas, one in the first portion of the duodenum and another in the second portion. Surgical consultation was subsequently obtained for fistula closure and cholecystectomy.

Discussion: Bouveret syndrome is a rare complication of cholelithiasis that requires prompt endoscopic or surgical treatment to prevent mortality. In recent years, endoscopic removal of obstructing gallstones has become a viable, well tolerated alternative to surgical treatment.

With advances in endoscopic techniques, the success rate has greatly improved in the recent years. Common methods used to break the large stone into pieces include endoscopic lithotripsy, extracorporeal shock wave lithotripsy, electro-hydraulic lithotripsy, and endoscopic laser lithotripsy. The latter two technologies are simple, safe, and effective, with few complications, and are currently the most commonly used methods.



Disclosures:


Santiago Garcia Ortiz, MD¹, Neha Khan, MD¹, Kayvon Sotoudeh, MD¹, Aida Rezaie, MD², Neil Vyas, MD¹, Savio Reddymasu, MD¹. P3742 - Bouveret Syndrome as a Cause of Gastric Outlet Obstruction: A Case Report, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.