Gallstone ileus is an exceptional complication among billiary diseases. It is defined as an intestinal obstruction caused by a gallstone as it passes through a bilio-digestive fistula. This is disease with high morbi-mortality, and whose main contributing factors are the advanced age of the patients, comorbidities and the delayed diagnosis. Most of the times, it is a postoperative diagnosis and a high clinical suspicion is essential for an early diagnosis. In patients with gallstone ileus the abdominal X-ray is frequently nonspecific and to observe a complete Rigler triad is exceptional.