Table of Contents Author Guidelines Submit a Manuscript
Diagnostic and Therapeutic Endoscopy
Volume 2008, Article ID 471512, 5 pages
http://dx.doi.org/10.1155/2008/471512
Case Report

Successful Multimodality Endoscopic Treatment of Gastric Outlet Obstruction Caused by an Impacted Gallstone (Bouveret's Syndrome)

1Section of Digestive Diseases, Department of Internal Medicine, Yale University School of Medicine, West Haven VAMC, CT 06510, USA
2Department of Surgery, Yale University School of Medicine, West Haven VAMC, CT 06510, USA

Received 7 May 2007; Accepted 13 November 2007

Academic Editor: Michael Conlin

Copyright © 2008 Jason N. Rogart et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Bouveret's syndrome is a rare condition of gastric outlet obstruction resulting from the migration of a gallstone through a choledochoduodenal fistula. Due to the large size of these stones and the difficult location in which they become impacted, endoscopic treatment is unsuccessful and most patients require surgery. We report the case of an elderly male who presented with nausea and hematemesis, and was found on CT scan and endoscopy to have an obstructing gallstone in his duodenal bulb. After several endoscopic sessions and the use of multiple instruments including a Holmium: YAG laser and electrohydraulic lithotripter, fragmentation and endoscopic removal of the stone were successful. We believe this to be the first case of Bouveret's syndrome successfully treated by endoscopy alone in the United States. We describe the difficulties encountered which necessitated varied and innovative therapeutic techniques.