## **Core Concept**
Gallstone ileus is a rare complication of gallstones, where a large gallstone enters the bowel through a fistula (usually a cholecystoenteric fistula) and obstructs the intestine. The management involves relieving the intestinal obstruction and addressing the gallstone.

## **Why the Correct Answer is Right**
The correct approach for treating gallstone ileus involves **surgical intervention** to relieve the bowel obstruction. The primary goal is to remove the stone that is causing the obstruction, which can often be done by making an **enterotomy** (a surgical incision into the intestine) at the site of obstruction to remove the stone. This approach is usually preferred because it is less invasive than a major bowel resection and can effectively relieve the obstruction.

## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is incorrect because while **endoscopic retrieval** might be considered for certain types of intestinal obstructions, it is not typically feasible or safe for large gallstones causing ileus due to the risk of bowel perforation.
- **Option B:** This option is incorrect as **dissolution therapy** with medications like ursodeoxycholic acid is used for small cholesterol gallstones and is not effective for large stones causing mechanical obstruction.
- **Option C:** This option might seem plausible but is incorrect because while **supportive care** and **bowel rest** are important aspects of managing ileus, they do not address the mechanical obstruction caused by the gallstone.

## **Clinical Pearl / High-Yield Fact**
A key point to remember is that gallstone ileus often occurs in elderly patients and may present with intermittent or incomplete obstruction initially. A high index of suspicion and early surgical intervention can significantly improve outcomes. Remember, the surgical approach often involves **enterotomy** for stone removal.

## **Correct Answer:** . Surgical removal of the stone.