Bouveret syndrome managed conservatively with the insertion of a double pigtail stent between the stomach and the gallbladder.
Garg, Joshua Wiggins, Tom Sahloul, Mohamed
Garg, Joshua
Wiggins, Tom
Sahloul, Mohamed
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University Hospitals Birmingham
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Publication date
2024-12-15
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Abstract
A woman in her early 90s presented to the acute surgical take with a 3-day history of worsening reflux, vomiting, epigastric pain and constipation. Subsequent imaging demonstrated two large, impacted gallstones in the pylorus and proximal jejunum secondary to a cholecystoduodenal fistula. A diagnosis of Bouveret syndrome was made, and endoscopic attempts to break down and remove the stones were unsuccessful. The stones were left in the stomach, with a pigtail stent placed through the fistula between the stomach and gallbladder to prevent the stones impacting again and to allow adequate drainage of the gallbladder to prevent further flare-ups. Due to the patient's comorbidities, it was decided to leave the stent in situ long term as opposed to surgical management. This has shown to be successful in follow-up. Our case highlights that Bouveret syndrome can potentially be managed conservatively long term in patients deemed unfit for major surgical intervention.
Citation
Garg J, Wiggins T, Sahloul M. Bouveret syndrome managed conservatively with the insertion of a double pigtail stent between the stomach and the gallbladder. BMJ Case Rep. 2024 Dec 15;17(12):e261558. doi: 10.1136/bcr-2024-261558.
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