Highlights Gallstone ileus is very infrequent and require high suspicion for preoperative diagnosis. It must be suspected in an elderly female with bowel obstruction and a history of recurrent episodes of acute cholecystitis. If during a cholecystectomy, cholecystoenteric fistula is found, it must be considered that Gallstone ileus could occur later. Mainly, gallstones larger than 2.5 cm that passes through a cholecystoenteric fistula are which could cause gallstone ileus.