Bouveret's syndrome: gallstone ileus causing gastric outlet obstruction.

CASE REPORT A 71-year-old lady presented with acute cholecystitis which settled with conservative treatment. She was readmitted four months later with another attack of acute cholecystitis. Three days after admission she began to vomit repeatedly. She had a positive succussion splash consistent with a diagnosis of gastric outlet obstruction. She was treated initially with nasogastric aspiration and intravenous fluids. A plain abdominal X-ray showed a large opacity in the upper abdomen to the right of the midline (Fig). A barium meal revealed a cholecystoduodenal fistula containing a large calculus which was causing partial gastric outlet obstruction. The radiological features were confirmed at laparotomy. A 6 cm gallstone was retrieved.