The records of 23 patients operated for gallstone ileus in a ten-year period were reviewed. The mean age was 75 and surgical procedure consisted always in the simple relief of obstruction without cholecystectomy and fistula interruption. Operative mortality was overall 17%; excluding two patients already perforated on admission; actual mortality due to uncomplicated ileus was 9%. One patient was at his second episode of gallstone ileus and in another the obstruction was sustained by two stones. The most common site of impaction was distal ileum, while a pyloro-duodenal obstruction with Bouveret's syndrome was noted in two cases. Since age was seen to be the only variable correlated with mortality it was concluded that surgical treatment of gallstone ileus in the elderly patient should be limited to simple relief of obstruction, in case leaving cholecystectomy to a subsequent second operation.