This is a case of Bouveret's syndrome (gastric outlet obstruction due to an impacted gallstone in either the pylorus or proximal duodenum), which is seen on both CT and MRI in this case.

Operative notes indicate that as an endoscope was advanced into the stomach, a large stone was seen within the lumen of the duodenal bulb. Given the size, it was not amendable to endoscopic retrieval. The case was converted to an open gastrotomy with extraction of three gallstones >5 cm each. The patient did well post-operatively. and was discharged 1 week after the surgery.

Co-author:
Christine Cooley, MD