Endoscopic treatment of Bouveret syndrome with a combination of electrohydraulic lithotripsy and balloon expansion: A case report
Abstract Bouveret syndrome is a rare type of ileus caused by the impaction of gallstones passing through a cholecystoenteric fistula in the duodenum. Endoscopic treatment with minimally invasive procedures is preferable for patients with this syndrome, typically for elderly individuals with a high s...
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Wiley
2023-04-01
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| Online Access: | https://doi.org/10.1002/deo2.232 |
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| author | Kotaro Watanabe Hirokazu Kawai Toshifumi Sato Masaaki Natsui Ryosuke Inoue Mayuki Kimura Kazumi Yoko Syun‐ya Sasaki Masashi Watanabe Yoshihisa Tsukada Shuji Terai |
| author_facet | Kotaro Watanabe Hirokazu Kawai Toshifumi Sato Masaaki Natsui Ryosuke Inoue Mayuki Kimura Kazumi Yoko Syun‐ya Sasaki Masashi Watanabe Yoshihisa Tsukada Shuji Terai |
| author_sort | Kotaro Watanabe |
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| description | Abstract Bouveret syndrome is a rare type of ileus caused by the impaction of gallstones passing through a cholecystoenteric fistula in the duodenum. Endoscopic treatment with minimally invasive procedures is preferable for patients with this syndrome, typically for elderly individuals with a high surgical risk. Conventional endoscopic techniques often fail to remove impacted stones that are generally large and occasionally solid. We report the case of an 88‐year‐old bedridden woman with severe dementia who presented with difficulty in breathing. The patient was diagnosed with aspiration pneumonia. In addition, computed tomography showed a cholecystoduodenal fistula and a gallstone 37 mm in diameter that impacted the duodenal bulb. Bouveret syndrome was diagnosed on the basis of the computed tomography findings. The impacted stone was too large and hard to split with standard endoscopic lithotripsy using grasping forceps, mechanical lithotripter, polypectomy snare, basket catheter, and electrohydraulic lithotripsy (EHL). However, EHL with a dual‐channel therapeutic endoscope was achieved to drill a narrow hole approximately 20 mm deep into the stone, in four sessions. The stone was subsequently split by inflating the balloon, which was inserted into the hole, to 10 mm in diameter at 3 atm. All the split stones were spontaneously excreted during defecation after a few days. If the gallstone is too hard to fragment by endoscopic EHL alone, a combination of EHL and balloon expansion might be a useful alternative. |
| format | Article |
| id | doaj-art-db43796d1a5849faa97ec14bf78bf1d9 |
| institution | Kabale University |
| issn | 2692-4609 |
| language | English |
| publishDate | 2023-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | DEN Open |
| spelling | doaj-art-db43796d1a5849faa97ec14bf78bf1d92025-08-20T03:49:36ZengWileyDEN Open2692-46092023-04-0131n/an/a10.1002/deo2.232Endoscopic treatment of Bouveret syndrome with a combination of electrohydraulic lithotripsy and balloon expansion: A case reportKotaro Watanabe0Hirokazu Kawai1Toshifumi Sato2Masaaki Natsui3Ryosuke Inoue4Mayuki Kimura5Kazumi Yoko6Syun‐ya Sasaki7Masashi Watanabe8Yoshihisa Tsukada9Shuji Terai10Department of Internal Medicine Niigata Prefectural Shibata Hospital Niigata JapanDepartment of Internal Medicine Niigata Prefectural Shibata Hospital Niigata JapanDepartment of Internal Medicine Niigata Prefectural Shibata Hospital Niigata JapanDepartment of Internal Medicine Niigata Prefectural Shibata Hospital Niigata JapanDepartment of Internal Medicine Niigata Prefectural Shibata Hospital Niigata JapanDepartment of Internal Medicine Niigata Prefectural Shibata Hospital Niigata JapanDepartment of Internal Medicine Niigata Prefectural Shibata Hospital Niigata JapanDepartment of Internal Medicine Niigata Prefectural Shibata Hospital Niigata JapanDepartment of Internal Medicine Niigata Prefectural Shibata Hospital Niigata JapanDepartment of Internal Medicine Niigata Prefectural Shibata Hospital Niigata JapanDivision of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences Niigata University Niigata JapanAbstract Bouveret syndrome is a rare type of ileus caused by the impaction of gallstones passing through a cholecystoenteric fistula in the duodenum. Endoscopic treatment with minimally invasive procedures is preferable for patients with this syndrome, typically for elderly individuals with a high surgical risk. Conventional endoscopic techniques often fail to remove impacted stones that are generally large and occasionally solid. We report the case of an 88‐year‐old bedridden woman with severe dementia who presented with difficulty in breathing. The patient was diagnosed with aspiration pneumonia. In addition, computed tomography showed a cholecystoduodenal fistula and a gallstone 37 mm in diameter that impacted the duodenal bulb. Bouveret syndrome was diagnosed on the basis of the computed tomography findings. The impacted stone was too large and hard to split with standard endoscopic lithotripsy using grasping forceps, mechanical lithotripter, polypectomy snare, basket catheter, and electrohydraulic lithotripsy (EHL). However, EHL with a dual‐channel therapeutic endoscope was achieved to drill a narrow hole approximately 20 mm deep into the stone, in four sessions. The stone was subsequently split by inflating the balloon, which was inserted into the hole, to 10 mm in diameter at 3 atm. All the split stones were spontaneously excreted during defecation after a few days. If the gallstone is too hard to fragment by endoscopic EHL alone, a combination of EHL and balloon expansion might be a useful alternative.https://doi.org/10.1002/deo2.232balloonBouveret syndromeelectrohydraulic lithotripsygallstonepneumonia |
| spellingShingle | Kotaro Watanabe Hirokazu Kawai Toshifumi Sato Masaaki Natsui Ryosuke Inoue Mayuki Kimura Kazumi Yoko Syun‐ya Sasaki Masashi Watanabe Yoshihisa Tsukada Shuji Terai Endoscopic treatment of Bouveret syndrome with a combination of electrohydraulic lithotripsy and balloon expansion: A case report DEN Open balloon Bouveret syndrome electrohydraulic lithotripsy gallstone pneumonia |
| title | Endoscopic treatment of Bouveret syndrome with a combination of electrohydraulic lithotripsy and balloon expansion: A case report |
| title_full | Endoscopic treatment of Bouveret syndrome with a combination of electrohydraulic lithotripsy and balloon expansion: A case report |
| title_fullStr | Endoscopic treatment of Bouveret syndrome with a combination of electrohydraulic lithotripsy and balloon expansion: A case report |
| title_full_unstemmed | Endoscopic treatment of Bouveret syndrome with a combination of electrohydraulic lithotripsy and balloon expansion: A case report |
| title_short | Endoscopic treatment of Bouveret syndrome with a combination of electrohydraulic lithotripsy and balloon expansion: A case report |
| title_sort | endoscopic treatment of bouveret syndrome with a combination of electrohydraulic lithotripsy and balloon expansion a case report |
| topic | balloon Bouveret syndrome electrohydraulic lithotripsy gallstone pneumonia |
| url | https://doi.org/10.1002/deo2.232 |
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