Endoscopically assisted minimally invasive surgery for gallstones

Area of Science:

• Gastroenterology
• Surgical Gastroenterology

Background:

• Bouveret syndrome is an uncommon cause of gastric outlet obstruction resulting from a gallstone eroding into the duodenum.
• It represents a rare variant of gallstone ileus, often presenting with obstructive symptoms.

Observation:

• An 85-year-old female presented with nausea, vomiting, and anorexia.
• Imaging revealed Bouveret syndrome caused by two large gallstones impacted in the duodenum.

Findings:

• Endoscopic extraction successfully moved stones from the duodenum to the stomach.
• Stones could not be removed endoscopically from the stomach, necessitating surgical intervention.
• A mini-transverse laparotomy and gastrotomy were performed for definitive stone removal.

Implications:

• This case highlights the challenges in managing Bouveret syndrome, particularly when endoscopic methods fail.
• A combined endoscopic and surgical approach may be necessary for complex cases.
• Effective management requires a thorough understanding of gallstone-related gastrointestinal complications.