Gallstone ileus is seen most often in elderly women and usually presents with vague, intermittent abdominal pain and vomiting. Moreover, patients may have hematemesis with hemorrhage at the biliary enteric fistula. At times, patients also have cholecystitis, fever, abdominal distention, and jaundice. An abdominal radiograph may show partial or complete bowel obstruction (50% of patients), stone (<15% of patients), and pneumobilia (30%-60% of patients). An abdominal computed tomographic scan may help in confirming the diagnosis by showing the gallbladder thickening, pneumobilia, intestinal obstruction, and gallstone.2The standard treatment of gallstone ileus is enterolithotomy performed by longitudinal enterotomy proximal to the point of impaction, removal of the stone, then transverse closure of the enterotomy. It is very important to inspect the remainder of the bowel for the presence of additional stones. In the past, most patients also underwent cholecystectomy in addition to enterolithotomy, but this practice has been abandoned owing to a significant increase in mortality.3In conclusion, gallstone ileus occurs in elderly women with vague abdominal pain, vomiting, and a history of cholelithiasis. The treatment is surgical enterolithotomy alone.