Gallstone ileus is a mechanical intestinal obstruction caused by passage of a large gallstone from the gallbladder into the gastrointestinal tract through a biliary-enteric fistula. Gallstone ileus is rare and accounts for less than 1% of intestinal obstruction. This is a 45-year-old man referred from a peripheral health facility for abdominal radiograph on account of sudden onset of abdominal distension, vomiting, restlessness, fever and weakness. The radiograph done in erect and supine views revealed a distended abdomen with extensive ground-glass appearance, paucity of bowel gas shadow with few air-fluid level, lucency around the region of the gall bladder (pneumobilia) and two near oval calcific density opacities above and lateral to the outline of the upper lobe of the right kidney, these opacities were noted to have descended inferiorly on the supine view; these are the Rigler’s triad of gallstone ileus. A diagnosis of intestinal obstruction following gallstone ileus was made; the relations were advised to meet a surgeon for expertise management to save the life of the patient. We present a case of gallstone ileus with intestinal obstruction and perforation due to its rare nature and peculiar presentation.