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Two cases are reported of acute intestinal obstruction associated with strangulation, each due to acute appendicitis. In one patient, appendicectomy was sufficient to cure the condition. but in the other, resection of about five feet of gangrenous ileum was required. Summary Two cases of acute intestinal obstruction caused by an acutely inflamed appendix encircling a loop of ileum are presented. In one case the gangrenous ileal segment had to be excised. This is a rare complication of a common disease.

Twenty‐seven patients with gall bladder perforation were reviewed. Free perforation into the peritoneal cavity producing bile peritonitis occurred in 45% of patients. Bilio‐enteric fistulae were encountered in 48% of our patients. Five patients had gall stone ileus. A mortality of 11% reflects the serious nature of the condition. Selection of the optimum surgical procedure is based on the evaluation of the individual patient which should include an estimate of the general condition of the patient as well as the evaluation of anatomic situation at operation. Our experience suggests that cholecystostomy may be life‐saving in these patients. Surgery in patients with gall stone ileus should be directed towards relief of obstruction only.

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