Bouveret's syndrome complicated by iatrogenic esophageal perforation after endoscopic gallstone retrieval: a case...

Bouveret's syndrome represents a rare variant of gallstone ileus characterized by the migration of a gallstone through a bilioenteric fistula into the duodenum, resulting in pyloric obstruction. We present the case of a 79-year-old woman who presented to a regional hospital with symptoms of vomiting and constipation. Diagnostic imaging revealed duodenal obstruction with multiple concretions and pneumobilia. An attempted endoscopic retrieval of the obstructing gallstones was complicated by an iatrogenic distal esophageal perforation, necessitating transfer to our tertiary care center for further management. Subsequent imaging and endoscopic assessment confirmed the findings and the patient underwent emergency surgical intervention comprising discontinuous resection of the perforated esophageal segment and excision of the cholecystoduodenal fistula. After clinical stabilization, esophageal reconstruction was performed 3 months later via retrosternal colon interposition. The postoperative course was uneventful. This case highlights the necessity of early interdisciplinary management and decision-making in gallstone-induced bowel obstructions and esophageal perforation.