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Background: Gallstone ileus is a very uncommon consequence of cholelithiasis, which is defined as mechanical intestinal obstruction caused by one or more large gallstones impaction in the digestive tract. It is caused by gallstones passing through the fistula from the bile duct into the intestinal lumen. The most frequently encountered type of fistula is between the gallbladder and the duodenum Case Presentation: A 63-year-old male presented to our emergency department with severe abdominal pain, nausea, and vomiting. For seven days prior to the onset of the illness, the patient experienced periumbilical abdominal pain with no apparent cause. Contrast-enhanced abdominal CT scan revealed gallstones ileus with stones with a diameter of +/-2.3 cm in the ileum and a suspicion of a fistula between the gallbladder and the duodenum, as well as between the gallbladder and the transverse colon. After that, the patient underwent emergency room surgery for a laparotomy. Then, the patient was admitted to the intensive observation room for one week and received intensive care. Throughout treatment, the patient's condition deteriorated due to sepsis-related complications and comorbidities. Conclusion: Rigler's triad (biliary tract obstruction, intestinal obstruction, and ectopic stones) is the most widely accepted imaging diagnostic criterion.

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