Causing severe colicky pain, vomiting, constipation – and often fever and dehydration as well – obstruction to the small intestines by gallstones is not often diagnosed but is still a condition to consider in the elderly patient. Drs Victoria Keevil, Divya Tiwari and Tim Battcock discuss the reasons why this diagnosis is often missed, its atypical presentations and why it should be explored in this age group.