Abstract Introduction Bouveret’s syndrome refers to gastric outlet obstruction secondary to ectopic gall stone(s) in the gastric pylorus or duodenum. It is a potentially fatal surgical emergency which is unlikely to resolve with conservative treatment. While surgical management is the standard therapeutic approach to the patient with Bouveret’s syndrome, endoscopic treatment is less invasive and may be ideal for carefully selected candidates. Case presentation An 82-year-old man with hypertension, type 2 diabetes and heart failure was referred to the emergency department with feeling unwell and vomiting for three days. On examination, his abdomen was soft and non-tender with bowel sounds present. Initial tests showed a hypokalaemic metabolic alkalosis with aciduria. However, the patient was incorrectly managed for pneumonia in a medical ward. Worsening abdominal distension and inflammatory markers prompted a surgical referral and a CT scan of his abdomen which showed gastric outlet obstruction with an ectopic gallstone in the anterior aspect of the pylorus, consistent with Bouveret’s syndrome. Management The patient was considered for operative management. However, following the advice of the regional hepatobiliary surgery team, a pre-operative oesophagogastroduodenoscopy (OGD) was performed. During the OGD, a 2cm x 2cm stone was found at the pylorus and retrieved with an endoscopic net. Following the procedure, the patient recovered uneventfully and was medically fit for discharge two days later. Conclusion While operative management is the commonest therapeutic modality for Bouveret’s syndrome, endoscopic management is an alternative approach in carefully selected patients who are high risk surgical candidates.
Akanji et al. (Fri,) studied this question.