The combination of cholecystoduodenocolic fistula with gallstone ileus is rarely seen. To our knowledge, there have only been six previous reports with these findings. A 66-year-old woman's condition was diagnosed preoperatively as small-bowel obstruction and communications between the gallbladder, duodenum, and colon. The small-bowel obstruction was successfully relieved by removing a large gallstone from the midileum, leaving the inflammatory mass in the right upper quadrant undisturbed. Three weeks later the small-bowel obstruction recurred. At reoperation two gallstones were found obstructing the midileum and were removed. The cholecystoduodenocolic fistula was dissected and the duodenum and colon were repaired. A cholecystostomy was done. The patient recovered and has been well four years later.