title: Bouveret's syndrome complicated by distal gallstone ileus after laser lithotropsy using Holmium: YAG laser.
abstract: BACKGROUND
  Bouveret's syndrome is an unusual presentation of duodenal obstruction caused by the passage of a large gallstone through a cholecystoduodenal fistula. Endoscopic therapy has been used as first-line treatment, especially in patients with high surgical risk.
  
  
  METHODS
  We report a 67-year-old woman who underwent an endoscopic attempt to fragment and retrieve a duodenal stone using a Holmium: Yttrium-Aluminum-Garnet Laser (Ho:YAG) which resulted in small bowel obstruction. The patient successfully underwent enterolithotomy without cholecystectomy or closure of the fistula.
  
  
  CONCLUSIONS
  We conclude that, distal gallstone obstruction, due to migration of partially fragmented stones, can occur as a possible complication of laser lithotripsy treatment of Bouveret's syndrome and might require urgent enterolithotomy.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Albany Medical College and VA Stratton Hospital, Albany, New York, USA.
authors.forename: Mohammad M
authors.initials: MM
authors.lastname: Alsolaiman
authors.forename: Christoph
authors.initials: C
authors.lastname: Reitz
authors.forename: Ali T
authors.initials: AT
authors.lastname: Nawras
authors.forename: John B
authors.initials: JB
authors.lastname: Rodgers
authors.forename: Benedict J
authors.initials: BJ
authors.lastname: Maliakkal
mesh_terms: D000368:Aged; D002769:Cholelithiasis / Q000150:complications* / Q000628:therapy*; D004380:Duodenal Obstruction / Q000209:etiology* / Q000628:therapy*; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005705:Gallbladder Diseases / Q000150:complications; D017219:Gastric Outlet Obstruction / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007077:Ileal Diseases / Q000150:complications / Q000628:therapy; D007412:Intestinal Fistula / Q000150:complications; D017602:Lithotripsy, Laser