This 75-year-old gentleman presented through the emergency room with signs and symptoms of intestinal obstruction. Ultrasound of the abdomen was initially requested and showed echogenic foci causing acoustic posterior shadowing within the liver parenchyma, and the gallbladder with dilated small bowel loops in the upper abdomen. CT scan of the abdomen and pelvis were advised by the radiology department for further evaluation, and showed intraluminal calcified rounded density in the jejunum with air pockets involving the intrahepatic biliary tree, gallbladder lumen, and the common bile duct. The diagnosis of gallstone ileus was made.

In patients with gallstone ileus, the stone tends to be large, and typically seen in the right iliac fossa, but can be lodged elsewhere in the small bowel like the jejunum in this case.