Background: Bouveret syndrome, is a rare form of gallstone ileus resulting in gastric outlet obstruction. It accounts only for 1 – 3 % of the cases of gallstone ileus. Because of the rarity of this condition specific therapeutic guidelines do not exist but the majority of cases will require surgical intervention. Methods: A 68 year old male was referred to our hospital due to hematemesis. He had a history of acute myocardial infraction, mild heart failure and hypertension. He had no significant findings in clinical examination and laboratory tests apart from anemia.The GI endoscopy revealed a bleeding erosion in the pyloric bolbus and a gallstone impacted in the 1st portion of the duodenum. CT revealed signs of cholecystitis, multiple gallstones of 1,5 cm in the duodenum and gallstones in the proximal jejunum causing obstruction. Results: The patient underwent exploratory laparotomy in which enterectomy and gallstone removal was performed in the jejunum as well as gastrotomy and gastrenteroanastomosis to remove the stones from the first portion of the duodenum. The patient had an uneventful postoperative course and was discharged on the 7th postoperative day. Conclusion: Due to its rarity, Bouveret syndrome requires a high index of clinical suspicion, especially in older patients with a history of cholelithiasis. X-ray, US, CT and endoscopy can assist diagnosis. Existing evidence supports a surgical intervention to remove the obstruction without intervention to the billiary tree.