Abstract Text
INTRODUCTION - Bouveret syndrome is a rare form of gallstone ileus in which a stone passes through a fistula and becomes impacted in the duodenum. Although surgery is the standard treatment, we present a case resolved endoscopically.
CLINICAL CASE - An 87-year-old woman referred to our centre due to obstruction from a 4 cm stone impacted in the duodenum after passing through a cholecystoduodenal fistula. Surgery was dismissed, so endoscopic therapy was used in three sessions. Initial EHL and polypectomy-snare attempts failed. Holmium laser lithotripsy (HLS) enabled partial fragmentation, and further fragmentation was achieved with a loop-shaped guidewire. Total fragmentation required HLS and EHL. The fragments were moved to the stomach, mechanically broken, and removed.
DISCUSSION - Endoscopic management can be effective in BS when surgery is contraindicated.