Background: gallstone ileus is a rare complication of cholelithiasis and considered as a type of mechanical bowel obstruction in which a gallstone is impacted in the gastrointestinal tract. This condition is seen more frequently in old patients with females' predominance. Gallstone ileus is responsible for 1%-5% of mechanical intestinal obstruction. Case presentation: we report a case of 48 years old medically free, male patient presented to Emergency Department with severe abdominal pain, distention, constipation, multiple attacks of vomiting associated with nausea and with a chronic history of cholecystitis. The diagnosis of gallstone ileus was confirmed by abdominal X-ray and abdominal computed tomography (CT) scan findings. The patient was stabilized before doing an exploratory laparotomy. Conclusion: gallstone ileus is an emergency condition associated with high morbidity and mortality rates. To get the most favorable outcome, high clinical suspicion aided by the use of diagnostic modalities such as CT abdomen is needed to reach the diagnosis since it is usually present with nonspecific signs and symptoms.