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BACKGROUND: Gallstone ileus (GI) is a mechanical obstruction in the intestinal lumen due to gallstones. Its prevalence is very low, but it possesses a high mortality rate. It is commonly found in older female population. CASE REPORT: We reported a case of GI in a 61-year-old Chinese female, who presented with acute onset of abdominal pain, nausea, and intermittent vomiting. On water-soluble contrast follow-through examination, she showed total bowel obstruction on the level of terminal ileum due to suspected gallstone. Exploratory laparotomy with procedure of enterolithotomy and stone removal by milking the bowel distal to the stone were performed. Post-operative course was uneventful, but the patient was discharged at post-operative day 8. Furthermore, the patient underwent cholecystectomy and fistula repair in the following days (two-stage surgery). She was followed up in the clinic for 12 months and the patient remained asymptomatic. CONCLUSION: GI is a rare medical condition with a high mortality rate, commonly affecting females and elder population. It must be considered in a patient with bowel obstruction, especially with a history of cholelithiasis. Many clinicians prefer enterolithotomy alone, followed by cholecystectomy at later date, because of its lower morbidity and report high spontaneous fistula closure.