The recognition of the specific nature of an obstructing lesion of the bowel is a vastly important expedient in the proper management of intestinal obstruction. With the introduction of suction therapy for the treatment of acute obstruction by Wangensteen and Paine,1the need for exact diagnosis has become even more pressing. While it is clear that in certain cases simple mechanical obstruction of the small bowel can be treated successfully without recourse to surgery, the management of obstruction of the small bowel by decompression is not without danger, especially when the exact nature of the lesion has not been ascertained. In certain instances of diagnostic uncertainty, suction decompression of the bowel postpones the inevitable train of events and creates a false sense of security. Gallstone ileus is one of the conditions in which temporizing procedures are not indicated; once this diagnosis is established, the hazard of any procedure other