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
Cholecystectomy alone
Removal of obstruction
Cholecystectomy, closure of fistula and removal of stone by enterotomy
Cholecystectomy with closure of fistula