: A 57-year-old woman was admitted to our hospital with abdominal pain and vomiting. Her abdomen was distended, and obstructive bowel sounds were discovered on examination. Diffuse abdominal tenderness was present, but no palpable masses were apparent. Abdominal computed tomography confirmed a large gallstone obstructing the small bowel. Colonoscopy revealed a large gallstone lodged at the terminal ileum, which was subsequently fragmented using electronic hydraulic lithotripsy EHL . The patient has remained asymptomatic for over 3 years of follow-up after the EHL treatment.Here, we present this case of small intestinal obstruction caused by a large gallstone in the lower ileum.