The treatment of gall stone ileus is -

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 (18/e 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, Maingot's and CSDTI