Parisi Stefanie, D'Agostino Dario, Di Bartolo Concetta Elisabetta, Petruzzellis Carlo, Scamporrino Alessandra, Piro Salvatore, Catarella Domenico
Gastroenterology Unit, Garibaldi-Nesima Hospital, 95122 Catania, Italy.
Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, 95122 Catania, Italy.
J Clin Med. 2025 Feb 25;14(5):1530. doi: 10.3390/jcm14051530.
Bouveret syndrome is a complication of cholelithiasis, characterized by the migration of a large gallstone from the gallbladder to a part of the stomach or intestine through a bilio-enteric fistula. This condition results in a rare form of gallstone ileus, presenting signs and symptoms of gastric outlet obstruction. This case report aims to present a rare instance of Bouveret syndrome in a 64-year-old woman who presented to our emergency department with recurrent epigastric pain and vomiting for over 2 months. After a CT scan, an esophagogastroscopy was performed following a multidisciplinary discussion. An endoscopic evaluation revealed a large (4 cm) gallstone found in the proximal duodenum using an endoscope. We then inserted the holmium laser fiber system through a standard ERCP catheter, passing it through the endoscope's working channel. By positioning the holmium laser fiber within the catheter, we stabilized the energy on the gallstone, which was then fragmented into smaller pieces after administering pulse energy. In this case report, we successfully treated Bouveret syndrome using endoscopic laser lithotripsy combined with mechanical lithotripsy, avoiding traditional surgery. The endoscopic approach that combines laser and mechanical lithotripsy appears effective in fragmenting large gallstones into smaller pieces, facilitating their passage through the digestive tract and resolving the obstruction.
布韦雷综合征是胆石症的一种并发症，其特征是大的胆结石通过胆肠瘘从胆囊迁移至胃或肠道的某一部分。这种情况会导致一种罕见的胆石性肠梗阻，表现为胃出口梗阻的体征和症状。本病例报告旨在呈现一名64岁女性布韦雷综合征的罕见病例，该患者因反复上腹部疼痛和呕吐2个多月前来我院急诊科就诊。CT扫描后，经多学科讨论进行了食管胃镜检查。内镜评估发现使用内镜在十二指肠近端发现了一个大的（4厘米）胆结石。然后，我们通过标准的内镜逆行胰胆管造影（ERCP）导管插入钬激光光纤系统，使其穿过内镜的工作通道。通过将钬激光光纤置于导管内，我们将能量稳定在胆结石上，在施加脉冲能量后，胆结石被破碎成较小的碎片。在本病例报告中，我们通过内镜激光碎石术联合机械碎石术成功治疗了布韦雷综合征，避免了传统手术。结合激光和机械碎石术的内镜方法似乎能有效地将大的胆结石破碎成较小的碎片，便于其通过消化道并解除梗阻。
