A 71-year-old woman with a past history of metabolic syndrome, asymptomatic gallbladder stones, and metastatic breast cancer (treated with capecitabine) presented to our hospital with nausea, vomiting, constipation, and abdominal pain. On examination, the patient was found to have mild abdominal distension, bulging sounds on percussion, and high pitched bowel sounds on auscultation. CT revealed a tumor with liver metastasis, a liquid-air flat in the small intestine, a biliary-enteric fistula (Figure A), and a large gallbladder stone at the end of the ileum (Figures B and C).　　We gave the patient emergency laparoscopic surgery and removed the gallstones by incising the ileum (Figure D; online video). The fistula and gallbladder embedded in the metastasis caused considerable surgical complications. Biliary intestinal obstruction is a complication of cholelithiasis. It occurs when a larger gallbladder stone becomes lodged in the small intestine. The prerequisite for a gallbladder stone to fall into the small intestine is a bile-intestinal fistula – the most common of which is a cholecystoduodenal fistula.