Objective: To analyze the clinical features of biliary ileus (BI) and current status of its diagnosis and treatment. Methods: The clinical data of 18 BI patients treated during January 1995 and December 2014 in Xiangya Hospital were reviewed, and the records of 284 BI patients from 22 Chinese articles published during the last 20 years were also collected. The clinical features of BI and current status of its diagnosis and treatment were extracted and analyzed. Results: Of the 302 patients, 86 cases (28.2%) were male and 216 cases (71.8%) were female; ages ranged from 36 to 89 with an average age of 63.4; preoperative diagnosis was 24.2% (73/302); 294 cases (97.4%) underwent enterotomy with stone extraction and 8 cases (2.6%) were subjected to intestinal resection and anastomosis; the stone lodged in the duodenum in 27 cases (8.9%), in the jejunum in 71 cases (23.5%), in the distal ileum in 201 (66.6%) and in the colon in 3 cases (1.0%); primary cholecystectomy was performed in 94 cases (31.1%) and choledocholithotomy was performed in 4 cases (1.3%); the incidence of postoperative complications was 27.2% (82/302) and mortality was 0.7% (2/302). Conclusion: BI frequently occurs in elderly women, its accurate preoperative diagnosis is unusual and incidence of postoperative complications is high.