Gallstone ileus is an uncommon cause of intestinal obstruction in Ghana. A patient with gallstone ileus that was diagnosed intra-operatively after being treated conservatively as adhesive small bowel obstruction for ten days is reported to highlight the importance of the clinical information in this condition. A 60-year-old Chinese male with recurrent intestinal obstruction who was initially being managed at a primary healthcare facility was subsequently referred to a tertiary hospital on account of computer tomography diagnosis of an intraluminal object obstructing the bowel. He had hypokalaemia that was corrected before surgery. Intra-operatively, a 4.5cm in diameter gallstone was removed from the terminal ileum. Gallstone ileus is rare in Ghana. A high index of suspicion is required to avoid a delay in diagnosis due to the low incidence of cholelithiasis in Ghana.

Foreign body ingestion is an uncommon cause of gastric outlet obstruction in adults. Not all ingested objects pass the gastrointestinal tract spontaneously. In most cases, endoscopic removal is required. A surgical approach is required if endoscopic removal is unsuccessful or in the event of a complication. We present a case of a 45-year-old woman, previously diagnosed endoscopically with chronic duodenal ulcer with pyloric stenosis, who presented with copious effortless offensive non-bilious vomiting, and epigastric pain of three weeks' duration. She was dehydrated with positive gastric succussion splash. Esophago-gastro-duodenoscopy showed an impacted neck-pendant occluding a stenosed pylorus which dislodged on attempts to extract it and was later excreted in the stool, with resolution of her symptoms.