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 proper extent of surgery continues to be actively debated. Proponents of minimal surgery feel that relief of the obstruction is all that is required. Others argue that the gallbladder and biliary-enteric fistula must be removed to prevent future recurrence (a one-stage procedure). The one-stage procedure carries an associated mortality of 16.9 per cent, compared to 11.7 per cent for simple enterolithotomy. Morbidity after enterolithotomy is low. The recurrence rate of gallstone ileus was less than 5 per cent, and only 10 per cent of patients required reoperation for continued symptoms related to the biliary tract. Simple enterolithotomy is both safe and effective in dealing with a patient with gallstone ileus.