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Gallstone ileus is an uncommon cause of small bowel obstruction, occurring when one or more large gallstones erode through the gallbladder and into the intestinal lumen. The presentation is often nonspecific with intermittent symptoms, confounding diagnosis, and delaying treatment. The traditional treatment is through open enterolithotomy. Thus far only 30 of over 400 case reports on MEDLINE describe laparoscopic enterolithotomy. In this article we describe a successful total laparoscopic approach to the treatment of gallstone ileus.