The management of gallstone ileus has primarily involved surgical intervention by enterolithotomy with or without bowel resection. Given that gallstone ileus is most common in elderly patients with comorbidities, the mortality and morbidity associated with surgical intervention are significant. We report a case of using electrohydraulic lithotripsy (EHL) to treat gallstone ileus in a patient with ileocolonic anastomotic stenosis. A 73-year-old male with a history of cirrhosis, Crohn's disease, prior small bowel resection and ileocolonic anastomosis presented with lower abdominal pain, nausea and vomiting. He underwent colonoscopy, which demonstrated an impacted 3 cm by 2 cm mixed pigment gallstone at the site of his prior ileocolonic anastomosis. This anastomosis appeared to have strictured. Previous attempts using a Roth net were unsuccessful in retrieving the stone. The patient was referred to an academic tertiary care center for further management of his gallstone ileus. He underwent a colonoscopy, where the gallstone was identified at the stenotic ileocolonic anastomosis. The anastomosis was dilated under endoscopic and fluoroscopic guidance to 20mm. Initial attempts to retrieve the stone with a Roth net were unsuccessful in pulling the stone through the anastomosis. The decision was made to perform electrohydraulic lithotripsy. The EHL generator and at a power level of 100 and shock frequency of 15 shocks/second was utilized. The lumen was perfused with saline to provide the fluid medium at the stone-probe interface for EHL. Shock waves were delivered which led to effective fragmentation of the stone. The fragmented stones were cleared from the small bowel entirely through using a Roth net basket. On 8 weeks follow-up, patient continues to remain asymptomatic. Technique Highlights: EHL in this instance was effective in fragmenting a large gallstone. In using this technique, complete immersion with saline should be used as the medium in the lumen of the bowel. Also care must be made to ensure constant visualization of contact of the EHL probe and the stone or fragment being targeted. Our case highlights the potential role of EHL to treat complicated cases of gallstone ileus in patients who are poor surgical candidates for enterolithotomy. Watch the video: https://goo.gl/ZkJcWb