We read with interest the editor’s quiz about Bouveret’s syndrome by Yau et al (Gut 2006;55:373, 387). We noted the comments that these cases are usually dealt with surgically, and carry a high morbidity. Recently, we had a similar case, which was managed without surgical intervention using mechanical lithotripsy as normally used at endoscopic retrograde cholangiopancreatography, avoiding the need for laparoscopic surgery.

A 79-year-old woman was admitted with a 2-month history of recurrent vomiting, abdominal pain and weight loss. A CT scan of the abdomen showed a grossly dilated stomach suggestive of gastric outlet obstruction due to stones in the second part of the duodenum (D2). A subsequent gastrografin follow through showed duodenal obstruction and a cholecystoduodenal fistula.

An oesophagogastroduodenoscopy showed an inflamed and narrowed pylorus with malignant-looking ulcer and apparent gallstones in the D2. To relive the symptoms of obstruction, …