Key Points for Cholelithiasis and Gallstone Ileus Prevention Following Biliointestinal Bypass.

Abstract

<strong>BACKGROUND</strong> 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. <strong>CASE REPORT</strong> 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. <strong>CONCLUSIONS</strong> 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.

• Authors: Giancarlo Micheletto, Guglielmo Niccolò Piozzi, Valerio Panizzo, Elisa Reitano, Domenico Tringali, Antonio Ettore Pontiroli
• Journal: The American journal of case reports (Am J Case Rep) Vol. 20 Pg. 993-997 (Jul 10 2019) ISSN: 1941-5923 [Electronic] United States
• PMID: 31326973 (Publication Type: Case Reports, Journal Article)

Topics

• Bariatric Surgery (adverse effects, methods)
• Gallstones (prevention & control)
• Humans
• Ileus (prevention & control)
• Jejunostomy (adverse effects)
• Male
• Middle Aged
• Obesity, Morbid (surgery)