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We herein report a case of gallstone ileus due to stone at terminal ileum. It is one of the rare complications of chronic cholelithiasis. The patient presented with features of small-bowel obstruction and distension of abdomen. The management dilemma was between simple enterotomy to relieve obstruction and to go for repair of cholecysto-duodenal fistula in addition. Management by only enterotomy as a single procedure has a good prognosis but has chances of recurrence, whereas repair of fistula in addition to enterotomy in the same setting has variable results in terms of morbidity. In this case, the primary repair of fistula was done in the first presentation itself with good results. Hence, primary repair of cholecysto-duodenal fistula is also an option in early presentation with no signs of peritonitis to reduce the morbidity of repeated surgeries.