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Biliary fistulae are an uncommon manifestation of gallstone disease. Bouveret syndrome, the eponymous name for a gastric outlet obstruction due to impaction of a large gallstone in the duodenum following cholecystoduodenal fistula, is an even rarer subset of biliary-enteric fistula. The pathology of this condition evolves from a gallstone causing pressure necrosis with the stomach or proximal duodenum. This is ultimately decompressed via a cholecystoenteric fistula. The gallstone then becomes impacted at the gastric outlet or proximal duodenum, causing gastric outlet obstruction. Classically, the gastric outlet obstruction causes vomiting with resultant hypochloremic, hypokalemic metabolic alkalosis (which when tested, exhibits paradoxical acidic urine). Our case highlights this unusual condition with a near-textbook electrolyte imbalance.A 67-year-old female presented to a tertiary hospital with a sixday history of intractable post-prandial vomiting associated with reduced bowel function. She had a similar episode of vomiting