An unusual presentation of cholecystoduodenal fistula: vomiting of gallstones.

Bouveret's syndrome is defined as gastric outlet obstruction secondary to an impacted gallstone in the duodenum via a cholecystoduodenal or cholecystogastric fistula. Common radiological findings include pneumobilia, calcified right upper quadrant mass, pyloric or duodenal obstruction and cholecystoduodenal fistula. Initial attempts through endoscopic retrieval may be successful; however, results can vary. Surgical options include enterolithotomy or gastrotomy with or without cholecystectomy and fistula repair. We describe a unique case of Bouveret's syndrome with short-lived obstruction followed by vomiting of gallstones in a morbidly obese patient and discuss the complexities of investigation and management of these patients.