Robotic Assisted Pyloroplasty for Bouveret’s Syndrome

Document Type

Conference Proceeding

Publication Date

5-2025

Publication Title

Surgical Endoscopy

Abstract

A 66 year-old male presented with 2 days of epigastric pain, nausea and emesis. Initial workup demonstrated gastric outlet obstruction on cross sectional imaging secondary to a large mass in the duodenum. Patient underwent an endoscopic gastroduodenoscopy and significant debris was seen causing inability to assess the antrum. The procedure was aborted and an NGT was inserted. The following day, patient returned for endoscopic gastroduodenoscopy where a large round mobile mass was encountered in the duodenum. After multiple unsuccessful attempts utilizing multiple methods, the decision to proceed with robotic assisted pyloroplasty. A transverse pyloroplasty was made from prepyloric channel to proximal duodenum. The 4.5 cm non-adherent, non-tissue appearing mass was able to be extracted and the pylorus was successfully closed and confirmed with a negative leak test during endoscopy. Pathology was consistent with a large gallstone. Bouveret’s Syndrome is a rare cause of gastric outlet obstruction and a rare variant of gallstone ileus. A bilioduodenal fistula forms due to chronic inflammation and subsequently the gallstone causes stone migration into the duodenal bulb. Morbidity and mortality rate is up to 30% for Bouveret’s syndrome and emergent treatment is recommended due to chance of spontaneous resolution being \1%.

Volume

39

Issue

Suppl 1

First Page

S381

Comments

SAGES Annual Meeting, March 12–15, 2025, Long Beach, CA

Last Page

S381

DOI

10.1007/s00464-025-11690-9

ISSN

1432-2218

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