<prompt> The treatment of gall stone ileus is -Cholecystectomy aloneRemoval of obstructionCholecystectomy, closure of fistula and removal of stone by enterotomyCholecystectomy with closure of fistula  <response>: Answer b i.e. Removal of obstruction The treatment priroity should focus on relief of obstruction and not on gall bladder and its fistulous communication. So the procedure of choice is - Laprotomy with stone extraction. The gallbladder disease can be dealt on later, which includes cholecystectomy and closure of the fistulous tract. Note that Sabiston 18e p1572, differs with the above management. It writes that - Takedown of the biliary-enteric fistula and cholecystectomy during the same procedure is warranted because recurrent cholecystitis and cholangitis are common. However, in patients with a significant inflammatory process in the right upper quadrant or who are unstable to withstand a prolonged operative procedure, the fistula can be addressed at a second laparotomy. However the above management is suppoed by Bailey, Harrison, Maingots and CSDTI 