A 59-year-old white woman with unresectable metastatic adenocarcinoma of the gallbladder and a malignant hilar stricture managed with palliative uncovered metal stents in a Y-shaped configuration and repeated radiofrequency ablation (RFA) for tumor ingrowth was incidentally found to have duodenal obstruction caused by a large stone pre- cluding a scheduled session of RFA. Because she had no complaints or symptoms related to the presence of the stone, a decision was made to abort the procedure and proceed with further assessment. A contrast-enhanced CT confirmed cholecystoduodenal fistula (Fig. 1), although no definite gallstone was identified implying its radiolucency. The diagnosis was compatible with Bouveret syndrome, and the patient agreed to endoscopic management using electrohydraulic lithotripsy (EHL) (Video 1, available online at www.VideoGIE.org).
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