# Bouveret’s syndrome complicated by iatrogenic esophageal perforation after endoscopic gallstone retrieval: a case report

## TL;DR

A rare case of Bouveret’s syndrome complicated by an iatrogenic esophageal perforation during gallstone retrieval is reported, emphasizing the need for careful interdisciplinary management.

## Contribution

This case report highlights a rare complication during endoscopic gallstone retrieval and underscores the importance of early interdisciplinary decision-making.

## Key findings

- A 79-year-old woman with Bouveret’s syndrome experienced an iatrogenic esophageal perforation during endoscopic gallstone retrieval.
- Emergency surgical intervention and later esophageal reconstruction with retrosternal colon interposition led to an uneventful recovery.
- The case emphasizes the need for early interdisciplinary management in complex gallstone-induced bowel obstructions.

## Abstract

Bouveret’s syndrome represents a rare variant of gallstone ileus characterized by the migration of a gallstone through a bilioenteric fistula into the duodenum, resulting in pyloric obstruction. We present the case of a 79-year-old woman who presented to a regional hospital with symptoms of vomiting and constipation. Diagnostic imaging revealed duodenal obstruction with multiple concretions and pneumobilia. An attempted endoscopic retrieval of the obstructing gallstones was complicated by an iatrogenic distal esophageal perforation, necessitating transfer to our tertiary care center for further management. Subsequent imaging and endoscopic assessment confirmed the findings and the patient underwent emergency surgical intervention comprising discontinuous resection of the perforated esophageal segment and excision of the cholecystoduodenal fistula. After clinical stabilization, esophageal reconstruction was performed 3 months later via retrosternal colon interposition. The postoperative course was uneventful. This case highlights the necessity of early interdisciplinary management and decision-making in gallstone-induced bowel obstructions and esophageal perforation.