Bouveret's syndrome: a rare consequence of malignant cholecystoduodenal fistula.

We report a case of duodenal gallstone obstruction, resulting from cholecystoduodenal fistula. Fistulization was associated with a repeat chronic inflammation and metastatic carcinomatous infiltration. The diagnosis was confirmed by ultrasonography, barium meal examination, and gastroscopy. An attempt at endoscopic extraction was unsuccessful and the patient was referred for operative therapy. We present a graphic algorithm for decision-making in Bouveret's syndrome.