Abstract: We report a case of Bouveret syndrome in a 78 year old woman presenting with 3 days of gastric distension,nausea and vomiting.CT showed an impacted high density lesion in the horizontal duodenum with suspected cholecystoduodenal fistula.Exploratory laparotomy revealed a contracted gallbladder adherent to the duodenal bulb;a firm 5.0cm×3.0cm stone was removed via a jejunal enterotomy approximately 20cm distal to the ligament of Treitz.Cholecystectomy and fistula repair were deferred due to dense adhesions.For large impacted stones or severe local inflammation,individualized surgical extraction with staged management of the gallbladder and fistula is a safe and effective strategy,and which can reduce the risk of complications.

Key words: cholelithiasis； ileus； Bouveret syndrome； cholecystoduodenal fistula