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We herein report a case of small bowel obstruction and ileus secondary to impaction of Gall stone at terminal ileum. It is one of the rare complications of cholelithiasis usually presents in a patient with long standing disease. She presented with features of small bowel obstruction and distention of abdomen. The management dilemma was between simple enterotomy to relieve obstruction and repair of cholecystoduodenal fistula in addition. Doing only enterotomy, has a good prognosis but has chances of recurrence but, repair of fistula in addition to enterotomy in same setting have variable results in terms of morbidity.