Objective To investigate the diagnosis and treatment of gallstone ileus and improve to recognize gallstone ileus. Methods The clinical data including clinical manifestations, imaging features, and treatment in 12 patients with gallstone ileus admitted to Northern Jiangsu People’s Hospital from January 2014 to December 2019 were retrospectively analyzed. Results All 12 patients had abdominal pain and distension, nausea and vomiting. Six cases with gallstone ileus were diagnosed preoperatively with 5 cases diagnosed by CT scanning and 1 case by magnetic resonance imaging. All cases, except 1 case non-surgical, had surgical treatment. A one-stage procedure consisting of enterolithotomy, cholecystectomy and fistula closure was performed in six cases with operative time(167.5±23.2) min and postoperative hospital stay (15.5±3.2) d. Five cases underwent simple enterolithotomy with operative time(96.2±31.1) min and postoperative hospital stay (16.25±2.7) d. The operative time in patients with simple enterolithotomy was shorter than that in patient with one-stage procedure(P<0.05). However, there was no significant difference in the postoperative hospital stay between simple enterolithotomy and one-stage procedure (P>0.05). One case with non-surgical treatment had spontaneous evacuation of gallstones, and both cholecystectomy and fistula closure were performed one year later. Conclusions Missed diagnosis of gallstone ileus might be present for the atypical symptoms. Abdominal CT examination is helpful for diagnosis of gallstone ileus and operative treatment is the key therapy.