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Gallstone ileus is an uncommon cause of small bowel obstruction, accounting for only 1–4% of all intestinal obstructions. In patients with cholelithiasis, only 0.3–0.5% reportedly develop gallstone ileus. However, the condition causes 25% of cases of non-strangulated small bowel obstruction in those over the age of 65 years. We report a patient with gallstone ileus who presented with small bowel obstruction that was initially misdiagnosed. The correct diagnosis was made based on finding an ectopic gallstone on plain abdominal radiography, a cholecystoduodenal fistula, and gallstone impaction in a small bowel follow-through study. [International Journal of Gerontology 2008; 2(1): 18–21]