
Introduction: Biliary ileus is defined as an intestinal obstruction caused by gallstones. It is due to the presence of a bile-digestive fistula and is common in people older than 60 years of age, mainly in women. Objective: To describe a case of biliary ileus in an average adult male patient treated with enterolithotomy and cholecystectomy. Presentation of the case: A 41-year-old male patient, with a diagnosis of biliary ileus and no known pathological history, who underwent surgical management with enterolithotomy and cholecystectomy at the same surgical time. He had subsequent surgical interventions and management in an intensive care unit, having a favorable outcome and hospital discharge. Conclusion: This case of intestinal obstruction in a patient with no abdominal surgical history and an atypical age presentation represents a challenge for clinical diagnosis of biliary ileus and its corresponding surgical management.