This is a report on nine cases presenting biliary ileus. All patients undergo operative management. Two female patients present Bouveret's syndrome. The inference is reached that gallstone induced intestinal obstruction is characterized by atypical clinical patterns, conditioning in turn the diagnostic difficulties encountered, and the necessity to undertake operative treatment against the background of advanced ileus. The latter is one of the rarest forms of intestinal obstruction. Biliary ileus treatment consists in the removal of small intestinal impatency. The concretion is pushed in oral direction, and its evacuation is successfully accomplished by enterotomy, duodenotomy or gastrotomy. Two fatal outcomes due to severe advanced form of ileus are reported.