This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: None, Subject name: Surgery
[{'content': 'The treatment of gall stone ileus is - \nSelect and explain. \nA. Cholecystectomy alone, B. Removal of obstruction, C. Cholecystectomy, closure of fistula and removal of stone by enterotomy, D. Cholecystectomy with closure of fistula', 'role': 'user'}, {'content': 'Answer: B \nExplanation: 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', 'role': 'assistant'}]