Gallstone ileus is a complication of biliary tree stones and was first described by Bartholin in 1654. In any localization, one or more gallstones may occlude as a result of access to the gastrointestinal tract via the bilioenteric fistula. In this article, we aimed to present a rare and operate with gallstone ileus cases of radiological and surgical imaging findings. A 74-year-old male patient presented with complaints of right upper quadrant pain, nausea, vomiting, and constipation in the last few days of the emergency department. Radiographical and computed tomography examination was done. The patient was urgently operated with gallstones. The ileal stone was removed in addition to cholecystectomy in the operation, and the cholecystododenal fistula detected during the operation was repaired. Gallstone ileus is an uncommon cause of a mechanical small bowel obstruction. Gallstone ileus should also be kept in mind in the elderly patients who have recurrent abdominal operation history with abdominal obesity findings of the omentum. In our case, we wanted to emphasize the importance of the radiological approach in diagnosing gallstone ileus disease in elderly patients with diabetes mellitus.