Rare presentation of gastric outlet obstruction with jejunal impaction of gall stones-the Bouveret’s syndrome

Gall stones related complications are very common in the world, Bouveret’s syndrome is one of rare (1-3%). presents a diagnostic and therapeutic challenge. We present case an 80-year-old lady diagnosed with gastric outlet obstruction jejunal impaction gallstones, because gallstone impacted jejunum 50 cm from duodenojejunal flexure. The patient was operated on enterotomy retrieval gall jejunum, roux en y gastrojejunostomy drainage procedure, gastro-duodenal fistula left situ, high risk unstable general condition our intra-operatively. had multiple pre-existing pre peri-operative comorbidities, fortunately, recovered discharged 21st postoperative days. Identifying Rigler’s triad symptoms synonymous diagnosing syndrome. However, classical only 40% cases, hence alertness degree suspicion required to differentiate other mechanical causes obstruction. atypical cases challenge surgeon for early diagnosis surgical management.