A case of Bouveret's syndrome treated by electrohydraulic lithotripsy with a biliary dilation catheter as outer probe

Abstract

Bouveret's syndrome is defined as gastric outlet obstruction following the impaction of a gallstone in the duodenum via a bilioenteric fistula. It is often treated surgically because the gallstone is large and difficult to treat endoscopically. In this study, we uncovered a case in which endoscopic electrohydraulic lithotripsy (EHL) was facilitated by using a biliary dilation catheter as outer probe. A 77-year-old woman presented to our hospital with a one-month history of anorexia and postprandial vomiting. Abdominal computed tomography revealed a 35-mm gallstone obstructing the proximal duodenum and a cholecystoduodenal fistula. We tried to remove the stone using mechanical lithotripsy; however, the procedure was unsuccessful. Subsequently, we tried to use EHL with biliary dilation catheter as outer probe, with which we have successfully removed the stone. The patient could avoid surgical treatment and the fistula closed spontaneously. We firmly believe that a biliary dilation catheter can be used as an outer for easier EHL.