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Key Points for Cholelithiasis and Gallstone Ileus Prevention Following Biliointestinal Bypass

Unusual clinical course, Unusual or unexpected effect of treatment, Educational Purpose (only if useful for a systematic review or synthesis)

Giancarlo Micheletto, Guglielmo Niccolò Piozzi, Valerio Panizzo, Elisa Reitano, Domenico Tringali, Antonio Ettore Pontiroli

Department of Surgery, Sant’Ambrogio Clinical Institute, Milan, Italy

Am J Case Rep 2019; 20:993-997

DOI: 10.12659/AJCR.916111

Available online:

Published: 2019-07-10

BACKGROUND: Biliointestinal bypass is a malabsorptive procedure for surgical treatment of morbid obesity. It is the evolution of jejunoileal bypass, and it is characterized by a cholecysto-jejunostomy on the proximal end of the excluded jejunum, therefore, allowing bile flow through the excluded bowel loop reducing the risk of postoperative diarrhea and malabsorption syndrome. Obesity is a well-known risk factor for cholelithiasis; moreover, bariatric surgery has been showed to increases the risk of gallstones formation.
CASE REPORT: A 48-years-old male (body mass index 42 kg/m²) received a laparoscopic biliointestinal bypass. Nine years later, the patient received a cholecystotomy for removal of biliary stones. No surgical procedures were performed on the cholecysto-jejunostomy. Fourteen years after the bariatric treatment, the patient underwent enterolithotomy after a diagnosis of gallstone ileus. The impacted biliary stone was documented in the excluded loop proximal to the anti-reflux valvular system. The postoperative course and 1-year follow-up were uneventful.
CONCLUSIONS: Few cases of gallstone ileus following biliointestinal bypass have been described in the literature. We report a new case and also propose few tips and tricks for cholelithiasis and gallstone ileus prevention after biliointestinal bypass.

Keywords: Bariatric Surgery, Gallstones, Obesity, Abdominal, Postoperative Complications