Bouveret syndrome managed conservatively with the insertion of a double pigtail stent between the stomach and the gallbladder.

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.