BACKGROUND: Bouveret’s syndrome is a gastric outlet obstruction due to a gallstone impacted in the duodenal lumen or in the stomach via a bilioenteric fistula. It’s the rarest form of gallstone ileus, with few cases reported in medical literature. Typically, this condition affects elderly people and causes high morbidity and mortality rates. METHODS: We present a review of the published cases of Bouveret’s syndrome between 2006, year of publication of the largest case series, and 2015 with particular regard to the operative management and treatment options. Two demanding cases of Bouveret’s syndrome reported in our Hospital are also described. RESULTS: Bouveret’s syndrome is a rare clinical condition and data reported in medical literature only derive from single case reports and case series. Therefore no clear management indications have been ruled out and treatment options are still matter of debate. CONCLUSION: Bouveret’s syndrome is a rare clinical entity with a challenging operative management. Surgical or endoscopic treatments should be tailored on patient medical conditions and clinical presentation.