Introduction: Cholecysto-enteric(CF) fistula is one of the complication of biliary lithiasis with incidence reported 3-5% of patients wuth cholelithiasis and in 0.15-4.8% of all patients undergoing operations on biliary tract. CF defined as a spontaneous track with bile flow between inflammed gallblader and one or more adjacent structures. Among all the internal fistulas, cholecysto-gastric fistula are not very common. They are mostly due to gallstones, gastric ulceration or in certain cases malignant infiltration of carcinoma of the gall bladder or stomach. Most of the time the clinical presentation will be similar to those with chronic cholecystitis and acid peptic disease, however with current advancement in radiological and endoscopic modalitites , early diagnosis can be obtained and surgical inervention can be planned ahead as elective case. Dilemma comes when patient presents with acute abdomen which warrants immediate surgery and on table decision making, increasing the morbidity and mortality also sometimes may lead to multiple surgeries. Method: Case report on a 63 years old gentleman, presented with vague symptoms of epigastric discomfort and fever over one week duration, who eventually underwent emergency laparotomy and was found to have a cholecysto-gastric fistula as a complication of calculus disease. Result: Prompt on table diagnosis and a successful 'one-stage' surgery which includes cholecystectomy, excision of cholecysto-gastric fistula and on table cholangiogram with a speedy recovery of patient post operatively eventually discharged well. Conclusion: Cholecystogastric fistula though rare, carries significant morbidity and mortality , thus requires prompt diagnosis and early treatment. With the advancement in radiological and endoscopic modalities, early accurate diagnosis can be made and proper surgical treatment can be outlined. However use of such modalities becomes restricted when patient presents acutely and unstable hemodnamically. Thus cholecysto-gastric fistula have to be kept as one of the differentials in case patients vague presentations