Acute biliary ileus (ABI) presents a rare form of upper intestinal occlusion, with an incidence of 2-3%. The presence of complications in gallstones is - 0.3%-0.5%. Mortality varies - 12% -27%, mostly due to delayed diagnosis, as well as diagnostic errors, caused by an unspecified clinical signs. Purpose: Evaluation of the results of diagnosis and treatment of patients with acute biliary ileus. Material and methods: Analyzed the effectiveness of diagnostic and treatment methods in 7 patients with ABI treated between 2014-2023. The age of the patients varied - 61 - 89 years. Women/men ratio - 5/2. Results: Abdominal X-ray showed completely Rigler's triad in 3 cases, in the others presenting only some components. The effectiveness of USG(5 cases) was the prevalence of other investigations, with the exposure o ectopically located gallstones(71,4%), pneumobilia(57,1%), obstruction with gastric and duodenal dilatation(5), perivesical free fluid(2). Surgical treatment included immediate resolution of occlusion and lithiasis - 6 cases - enterotomy with lithextraction, cholecystectomy with drainage of the bile ducts, predominantly the Holsted procedure(4) and suturing of the duodenal defect. In one patient with multiple severites, only enterotomy with lithextraction was performed. One patient died as a result of the dexiscent of the jejunal sutures with progressive total peritonitis. Conclusion: The diagnosis of ABI requires an extremely high degree of suspicion, in patients with gallstones for many years, who clinically present symptoms of upper intestinal occlusion. Rx and USG are capable of finalizing the diagnosis with indications for emergency surgery. The therapeutic attitude requires an individualization, the objectives of the intervention being adapted to the particularities of the case.