Endoscopic Management of Bouveret Syndrome Complicated by Jejunal Perforation.

Bouveret syndrome is a rare cause of gastric outlet obstruction due to gallstone migration through a bilioenteric fistula. We present a 76-year-old woman with multiple comorbidities who developed Bouveret syndrome and was treated with endoscopic holmium laser lithotripsy. Although the obstructing stone was successfully fragmented and removed, the patient later developed a jejunal perforation. She was ultimately transitioned to hospice care. To our knowledge, jejunal perforation after endoscopic laser lithotripsy for Bouveret syndrome has not been previously reported. This case highlights a rare but serious complication of minimally invasive endoscopic management, particularly in high-risk patients with large stones.