Although rare in the general population, gallstone ileus accounts for
25 per cent of nonstrangulated small bowel obstructions in those over
the age of 65. While mortality has declined over the years, it remains
high at 15-18 per cent. This is largely due to the patient population
, with comorbid medical conditions contributing to mortality. The prop
er extent of surgery continues to be actively debated. Proponents of m
inimal surgery feel that relief of the obstruction is all that is requ
ired. Others argue that the gallbladder and biliary-enteric fistula mu
st be removed to prevent future recurrence (a one-stage procedure). Th
e one-stage procedure carries an associated mortality of 16.9 per cent
, compared to 11.7 per cent for simple enterolithotomy. Morbidity afte
r enterolithotomy is low. The recurrence rate of gallstone ileus was l
ess than 5 per cent, and only 10 per cent of patients required reopera
tion for continued symptoms related to the biliary tract. Simple enter
olithotomy is both safe and effective in dealing with a patient with g
allstone ileus.