Novel endoscopic approach for Bouveret syndrome: a case report on successful lithotripsy with laser for giant duodenal gallstone removal

Abstract

Bouveret syndrome is a rare form of gastric outlet obstruction resulting from gallstone migration through a bilioenteric fistula. Fewer than 300 cases have been reported in the literature, to our knowledge. We present the case of a 68-year-old man with severe postprandial pain, recurrent vomiting, and significant weight loss. Laboratory tests revealed severe anemia, metabolic acidosis, and acute kidney injury. Imaging and upper endoscopy identified a large duodenal gallstone associated with a cholecystoduodenal fistula and ischemic gastric ulcers. The patient underwent endoscopic management with laser lithotripsy and fragment extraction, achieving complete resolution of the obstruction. This case highlights the feasibility and effectiveness of endoscopic therapy, particularly laser lithotripsy, as a minimally invasive alternative to surgery in patients with Bouveret syndrome who present with high surgical risk.