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Key Points for Cholelithiasis and Gallstone Ileus Prevention Following Biliointestinal Bypass

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


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.

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