Endoscopic view of a gall stone impacted in the duodenum

A 72 year old man presented with severe episodic upper abdominal pain which settled spontaneously. He was left with recurrent vomiting requiring placement of a nasogastric tube. Upper gastrointestinal endoscopy revealed a gall stone impacted in the first part of the duodenum. Endoscopic removal was not possible. At laparotomy, the gall bladder was found to be adherent to the duodenum. The stone was manipulated into the stomach and removed via a gastrotomy. The postoperative period was complicated by an ischaemic cardiovascular accident from which the patient is now recovering.