PMC2666152_01
A gallstone in the duodenum and a distended stomach was seen on CT scan.
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fig1
CT of the abdomen revealed pneumobilia, the presence of a biliary stent, a distended stomach and a 3.3 cm hypodense oval object in the second portion of the duodenum suggestive of Bouveret's Syndrome (Figure 1). 
Endoscopic image showing the gallstone causing obstruction.
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fig2
Initial esophagogastroduodenoscopy (EGD) revealed large amounts of fluid and food content in the stomach with poor visualization of the duodenum due to retained food and a large stone in the second part of duodenum causing complete obstruction of its lumen (Figure 2).
Fistula and surrounding ulceration of the duodenum on endoscopy.
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fig3
A cholecystoduodenal fistula was visualized beneath the level of the stone on subsequent endoscopy (Figure 3).