Gall stone ileus is an intraluminal obstruction of the intestine usually just above ileocaecal valve as a result of impacted gallstone, which has created an internal biliary fistula. Gallstone enters GI tract through fistula between gall bladder and stomach or duodenum: if it is smaller than 2 cms it may be vomited out, or if bigger than 2.5 cms can obstruct pylorus, duodenal bulb, duodeno-jejunal junction or terminal ileum, the last being the commonest. The patient is usually an elderly, a febrile female with a history of chronic cholecystitis. The onset may be insidious, with severe nausea, but rapidly progresses to persistent vomiting. There is colicky abdominal pain along with persistent pain in the right upper quadrant; the later may get relieved once vomiting starts. Plain X-ray of abdomen-taken in standing shows gas in biliary tract, multiple fluid levels and may be show biliary stone lodged in duodenum or terminal ileum. Correct diagnosis is possible in around 75 percent cases and warrants emergency surgery after correcting electrolytes and fluid imbalance. If patient general condition is good, relief of obstruction by removal of stone (manual propulsion into caecum or enterotomy-removal stone and 2 layer repair) along with cholecystectomy is recommended. Mortality is around 20 percent. If patient’s condition is not very favorable, relief of intestinal obstruction along with cholecysto­stomy followed by cholecystectomy at a later date is recom­mended.