Duodenal Obstruction Due to Giant Gallstone: A Case Report

Bac Hoang Nguyen,1 Anh Tuan Le Quan,2 Pham Minh Hai,2 Vu Quang Hung,3 Truc Thanh Thai4 1University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam; 2Department of Hepatobiliary and Pancreatic Surgery, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam; 3Department of General Surgery, University of Medicine and Pharmacy Ho Chi Minh City, Ho Chi Minh City, Vietnam; 4University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, VietnamCorrespondence: Truc Thanh ThaiUniversity of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang Street, District 5, Ho Chi Minh City, VietnamTel +84-908-381266Email thaithanhtruc@ump.edu.vnBackground: Duodenal obstruction due to a gallstone, also known as Bouveret’s syndrome, is one type of gallstone ileus. This is a rare complication of cholelithiasis. Among gallstone ileus cases, duodenal obstruction is alsorare. Apart from rareness, diagnosis is challenging due to unspecific clinical manifestation. Treatment options have benefits and drawbacks with each as well. Therefore, setting an appropriate option in a certain patient is an important issue.Case Report: An 85-year-old woman presented clinically with a gastric outlet obstruction. Upper gastrointestinal (GI) endoscopy was attempted but endoscopic exploration was limited because of duodenum filled by fluid. Rigler’s triad was detected on abdominal enhanced CT scan: duodenal obstruction, ectopic gallstone within duodenum lumen, pneumobilia. The stone was very large (9 cm long). The diagnosis was duodenal obstruction due to giant gallstone and cholecysto-duodenum fistula. The patient was treated with a radical one-stage procedure: fistulotomy for gallstone removal, cholecystectomy, side-to-side Roux-en-Y duodenojejunostomy. There were no complications related to surgery during the follow-up period.Conclusion: Surgery plays an important role in management of duodenal obstruction due to a gallstone, especially a large and impacted stone. Radical one-stage surgery is one of the feasible, safe, and efficient procedures in selected patients.Keywords: duodenal obstruction, giant gallstone, gallstone ileus, Bouveret syndrome, Bouveret’s syndrome