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We report two unusual cases of Bouveret's syndrome causing gastric outlet obstruction in two elderly patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation:<\/jats:title>\n                    <jats:p>Two elderly female patients presented to the surgical assessment unit with features of gastric outlet obstruction. In both cases, an urgent computed tomography (CT) of the abdomen showed pneumobilia, gastric distension, and gallstones impaction at the duodenal bulb. In Patient 1, endoscopic removal of the impacted gallstones was done successfully. She was discharged three days following an uneventful recovery. In Patient 2, an endoscopic removal of a single large gallstone was attempted, which was unsuccessful. She underwent robotic gastrotomy with extraction of the large gallstone with primary repair. She was discharged on 8th postoperative day.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical discussion:<\/jats:title>\n                    <jats:p>Treatment options for Bouveret's syndrome include endoscopic management and surgery. The selection of treatment options depends upon factors like the degree of obstruction, the impaction site, number, type or size of gallstones, patient co-morbidities and clinical parameters at presentation, as well as expertise available, both endoscopic and surgical.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Bouveret's syndrome is one of the rare complications of gallstone. Endoscopic management can be effective at removing the impacted gallstones, which is particularly helpful for those elderly patients who have multiple medical co-morbidities, as in our first patient. Surgical management like minimal invasive surgery (robotic) can be beneficial in failed endoscopic attempt of removal of stone like in the second patient.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2023.109134","type":"journal-article","created":{"date-parts":[[2023,12,8]],"date-time":"2023-12-08T02:54:08Z","timestamp":1702004048000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":9,"title":["Bouveret's syndrome: An old diagnosis. A modern multimodality approach (endoscopic and robotic surgical) of gastric outlet obstruction: Report of two cases"],"prefix":"10.1097","volume":"114","author":[{"given":"Tika Ram","family":"Bhandari","sequence":"first","affiliation":[{"name":"Department of Upper Gastrointestinal and Bariatric Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Lin Hieng","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Endoscopy, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jawad","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department of Hepatobiliary and Pancreatic Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalid","family":"Akbari","sequence":"additional","affiliation":[{"name":"Department of Upper Gastrointestinal and Bariatric Surgery, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinod","family":"Menon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"1","key":"R1-48-20260325","doi-asserted-by":"crossref","first-page":"25","DOI":"10.4240\/wjgs.v9.i1.25","article-title":"Uncommon presentation of a common disease - Bouveret's syndrome: a case report and systematic literature review","volume":"9","author":"Al-Habbal,","year":"2017","journal-title":"World J. 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