Gastric Outlet Obstruction Caused by External Compression by a Giant Gallstone Treated With Laparoscopic Cholecystectomy: A Case Report

TL;DR

A rare case of gastric outlet obstruction caused by a giant gallstone was successfully treated with laparoscopic cholecystectomy.

Contribution

Demonstrates laparoscopic cholecystectomy as a safe treatment for GOO caused by external compression from a large gallstone.

Findings

Computed tomography showed a giant gallstone compressing the duodenum without a bilioenteric fistula.

Laparoscopic cholecystectomy resolved the obstruction with no complications.

External compression by non-migrated gallstones can cause gastric outlet obstruction.

Abstract

Gastric outlet obstruction (GOO) caused by gallstones is classically described as Bouveret’s syndrome and results from the impaction of a migrated stone through a bilioenteric fistula. GOO due to external compression by a non-migrated gallstone is exceptionally rare. We report the case of a 71-year-old male presenting with recurrent projectile vomiting and epigastric distension. Computed tomography revealed marked gastric dilatation caused by extrinsic compression of the duodenum from a giant gallstone measuring approximately 8 cm, without evidence of fistula or inflammation. Initial conservative management provided temporary relief; however, symptoms recurred, and the patient underwent emergency laparoscopic cholecystectomy. Intraoperatively, the gallbladder containing the giant gallstone was found to be externally compressing the duodenum, with intact anatomical planes and no fistula. The postoperative course was uneventful, and oral intake was successfully resumed. This case highlights a rare mechanism of gastric outlet obstruction caused by external compression from a giant gallstone and demonstrates that laparoscopic cholecystectomy can be a safe and effective treatment option, even in the presence of very large gallstones.

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