An unusual case of gallstone ileus with rare spontaneous resolution and literature review.

Gallstone ileus is a rare cause of mechanical bowel obstruction, typically affecting elderly patients with a history of gallstones. It results from the migration of a gallstone through a cholecystoenteric fistula into the bowel, most commonly lodging in the ileum. We report a case of a 59-year-old female who presented with small bowel obstruction caused by a 22 mm gallstone. During diagnostic laparoscopy, no obstructing stone was found, and subsequent imaging revealed its migration to the descending colon. The patient was successfully managed conservatively without surgical intervention. This case emphasizes the importance of considering gallstone ileus in elderly patients presenting with obstruction and demonstrates that conservative management may be an option in select cases, particularly when the stone progresses distally. Repeat imaging and a multidisciplinary approach are essential for optimal outcomes.