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• W2978957416 abstract "We describe two cases of duodenal obstruction caused by an impacted gallstone (Bouveret's syndrome) successfully treated with endoscopic therapy using electrohydraulic lithotripsy. Case 1: An 84-year-old man presented with two days of nausea and recurrent coffee-ground emesis. His medical history included a shallow duodenal bulb ulcer on endoscopy one month earlier, and a large (3 cm) solitary gallstone in the gallbladder on abdominal imaging six months previously. On admission, plain abdominal radiographs revealed a markedly distended stomach. Endoscopy revealed a large gallstone impacted in the duodenal bulb, prohibiting passage of the endoscope. Magnetic resonance cholangiopancreatography (MRCP) demonstrated a cholecystoduodenal fistula. Due to the size of the impacted stone, fragmentation using mechanical lithotripsy was not feasible. Therefore, intracorporeal endoscopic electrohydraulic lithotripsy (Northgate Technologies, Inc., Arlington Heights, IL.) using the Micro II 1.9 French lithotripsy probe at a setting of 70–100 watts was used to successfully fracture the stone into small fragments. Clinically, the patient's gastric outlet obstruction resolved. Follow-up endoscopy three days later revealed no remaining stone fragments in the duodenum. Case 2: A 69 year-old man presented with four days of right upper quadrant pain, nausea and vomiting in the setting of known cholelithiasis. After treatment for presumed cholecystitis, he was taken to the operating room for laparoscopic cholecystectomy. Significant inflammation was encountered in the perihepatic region; thus cholecystectomy was deferred and a percutaneous drain was placed. A post-operative CT scan suggested extravasation of oral contrast from the duodenum toward a perihepatic fluid collection, and a round filling defect was demonstrated in the proximal duodenum on upper GI. Subsequent endoscopy revealed a large obstructing gallstone in the duodenal bulb. Intracorporeal endoscopic electrohydraulic lithotripsy was performed at 70–90 watts with successful fragmentation of the stone. An opening to a fistulous tract was then identified in the duodenal bulb. The patient improved clinically and was discharged 15 days after endoscopy, with plans to pursue cholecystectomy in the outpatient setting. These cases illustrate the potential for effective endoscopic therapy for this historically surgical condition, which is particularly desirable in elderly patients with significant medical comorbidities." @default.
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• W2978957416 date "2006-09-01" @default.
• W2978957416 modified "2023-09-26" @default.
• W2978957416 title "Successful Endoscopic Treatment of Bouveretʼs Syndrome with Intracorporeal Electrohydraulic Lithotripsy" @default.
• W2978957416 doi "https://doi.org/10.14309/00000434-200609001-00682" @default.
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