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Background: Gallstone ileus is a rare, serious and usually specific to elderly age complication of cholecystolithiasis associated with very high mortality. It occurs when a concrement from the gallbladder becomes incarcerated in the lumen of the digestive tract. In this report, a case of gallstone ileus is presented, where a concrement moved through a cholecystoduodenal fistula to the lumen of the small intestine. Case report: A 80-year-old woman who suffered from cholecystolithiasis and diabetes mellitus was admitted to hospital with abdominal pain, flatulence and loss of appetite which lasted a few days. In ultrasonography of the abdomen, a gallbladder hydrops was found and the patient was qualified to cholecystectomy. The night before the planned surgery, the patient reported her abdominal complaints to more intense, and vomiting occurred. Abdominal ultrasonography was repeated, revealing wide intestinal loops with the gallbladder poorly visible; the examiner also noticed a hyperechogenic shadow in the stomach and in conclusions suggested the possibility of perforation. In CT imaging, one concrement in the jejunum and several ones in the colon were found to confirm the diagnosis. During the surgery, perforations of the gallbladder and pylorus were found and a gallstone wedged in the lumen of the jejunum blocking the passage. Conclusions: Cholecystolithiasis, as a disorder common in our population, should be considered in differential diagnosis of intestinal obstruction. Gallstone ileus as a rare but highly dangerous complication of cholecystolithiasis is more often seen in elderly patients with rich medical past. None of radiological methods used separately is able to give a full diagnosis - only their combination leads to an accurate diagnosis. That is why only rapid and well selected path of imaging diagnostics (ultrasonography, plain abdominal radiogram, CT imaging), good anamnesis and cooperation with a clinician is the way to obtain a therapeutic success.