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      Bouveret's syndrome complicated by distal gallstone ileus after laser lithotropsy using Holmium: YAG laser

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          Abstract

          Background

          Bouveret's syndrome is an unusual presentation of duodenal obstruction caused by the passage of a large gallstone through a cholecystoduodenal fistula. Endoscopic therapy has been used as first-line treatment, especially in patients with high surgical risk.

          Case presentation

          We report a 67-year-old woman who underwent an endoscopic attempt to fragment and retrieve a duodenal stone using a Holmium: Yttrium-Aluminum-Garnet Laser (Ho:YAG) which resulted in small bowel obstruction. The patient successfully underwent enterolithotomy without cholecystectomy or closure of the fistula.

          Conclusion

          We conclude that, distal gallstone obstruction, due to migration of partially fragmented stones, can occur as a possible complication of laser lithotripsy treatment of Bouveret's syndrome and might require urgent enterolithotomy.

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          Most cited references12

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          Cholecystectomy and fistula closure versus enterolithotomy alone in gallstone ileus.

          The management of gallstone ileus is controversial. This study compared the results of simple enterolithotomy with those of enterolithotomy, cholecystectomy and fistula closure. A retrospective analysis was made of 25 patients with a mean age of 75 (range 55-84) years. Enterolithotomy was performed in 16 patients (group 1) and cholecystectomy and fistula closure were added in nine patients (group 2). The diagnosis was made before operation in 12 patients, and was associated with previous biliary disorder (P = 0.03) and pneumobilia (P < 0.001). Postoperative morbidity occurred in eight patients in group 1 and in six in group 2. Three patients died in each group; all but one of the deaths were unrelated to the surgical procedure. There was no relationship between age and mortality, and patients in American Society of Anesthesiologists (ASA) classes III and IV did not have higher rates of morbidity or mortality than those in ASA classes I and II. Evidence from this study does not support one-stage enterolithotomy, cholecystectomy and fistula closure as the procedure of choice; simple enterolithotomy is appropriate in most patients. However, the one-stage procedure may be acceptable in patients at low risk.
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            Successful endoscopic therapy of a gastric outlet obstruction due to a gallstone with intracorporeal laser lithotripsy: a case of Bouveret's syndrome.

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              Endoscopic treatment of gastric outlet obstruction caused by a gallstone (Bouveret's syndrome) after extracorporeal shock-wave lithotripsy.

              Two patients with gastric outlet obstruction caused by a gallstone were treated by endoscopic lithotripsy. All fragments of significant size were removed orally, except for one that was left in the stomach in the first patient. This fragment caused a recurrent ileus after initial clinical improvement. The other patient remained clinically well after hospital discharge.
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                Author and article information

                Journal
                BMC Gastroenterol
                BMC Gastroenterology
                BioMed Central (London )
                1471-230X
                2002
                18 June 2002
                : 2
                : 15
                Affiliations
                [1 ]Division of Gastroenterology, Department of Medicine, Albany Medical College and VA Stratton Hospital, Albany, New York, USA
                Article
                1471-230X-2-15
                10.1186/1471-230X-2-15
                117132
                12086587
                9679aba5-03d3-4aa0-970f-57380769df38
                Copyright © 2002 Alsolaiman et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.
                History
                : 18 April 2002
                : 18 June 2002
                Categories
                Case Report

                Gastroenterology & Hepatology
                Gastroenterology & Hepatology

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