Gallstone ileus, although uncommon, requires urgent and appropriate surgical therapy if unacceptable morbidity and mortality are to be avoided. Enterolithotomy alone remains the mainstay of operative treatment for gallstone ileus, but the additional performance of a one-stage cholecystectomy and repair of fistula if desirable if the condition of the patient will allow it. One must use good judgment in selecting a surgical procedure. It is imperative to recall that the primary goal in the surgical treatment of gallstone ileus is to save a life. Future complications of the diseased gallbladder and the cholecystoenteric fistula may be treated electively under more ideal circumstances when and if they occur. Gallstone ileus, like other complications of cholelithiasis, remains a strong argument for early cholecystectomy in patients with gallstones.