Abstract: Gallstone ileus is a rare and potentially serious complication of cholelithiasis. Its clinical symptoms are nonspecific. From March 2005 to September 2012, 19 patients with gallstone ileus confirmed by surgery or endoscopy were admitted to the Pudong New Area People′s Hospital. The accuracies of Xray, ultrasonography, CT and magnetic resonance imaging (MRI) were 0/10, 0/5, 19/19 and 9/9, respectively. CT examination might be the first choice for diagnosing gallstone ileus; the classical computed tomography (CT) presentation of gallstone ileus was the Rigler triad, including pneumobilia, ectopic stone and mechanical ileus; MRI examination was superior to CT examination in exposing the fistula, and can provide abundant information, which is important for designing the surgical procedures and judging the prognosis; Xray and ultrasonography are beneficial in screening the diseases.