A 95 year-old woman presented with upper abdominal pain and jaundice; ultrasound demonstrated gallstones. Symptoms were short in duration, and jaundice began to clear rapidly. In view of her age and improving condition, she was treated conservatively for cholecystitis. However, she then developed protracted vomiting; endoscopy demonstrated several stones in the duodenum (left), the largest of which was impacted in the lumen, causing obstruction. This stone could not be removed endoscopically. Surgery confirmed the suspicion that the gallbladder had perforated into the duodenum, releasing the stones into the duodenal lumen. Measurement of the largest stone after surgical removal revealed it to be over 5 cm in length (right).