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A 62 year old woman presented with the symptoms of a gastric outlet obstruction together with severe metabolic hypochloremic alcalosis. A gallstone in the duodenum with gastric outlet obstruction was diagnosed by abdominal ultrasonography. In a one-stage surgical procedure, cholecystectomy, enterolithotomy and repair of the cholecytoduodenal fistula were performed. The postoperative course was uneventful. Pathogenesis, clinical findings, diagnostic procedures and therapeutic options of gastric outlet obstruction secondary to a gallstone impacted in the duodenal bulb (Bouveret's Syndrome) are discussed.