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J Gastrointest Surg. 2013 Dec;17(12):2162-5. doi: 10.1007/s11605-013-2290-6. Epub 2013 Jul 30.

Gallstone ileus after biliointestinal bypass: report of two cases.

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  • 1Department of Pathophysiology and Transplantation-Department of General Surgery, Universit√† degli Studi di Milano-Istituto Clinico Sant'Ambrogio, via Faravelli 16, 20149, Milan, Italy, giancarlo.micheletto@unimi.it.



Gallstone ileus is an uncommon disease and accounts for 1-4 % of all cases of mechanical intestinal obstruction. The physiopathology is related to the presence of a bilioenteric fistula.


We report two cases of gallstone ileus in patients operated on biliointestinal bypass for morbid obesity. The anastomosis of the gallbladder to the proximal end of the bypassed jejunum allowed the transit of gallstones in the excluded ileum and its impaction in anti-reflux valvular system.


Preoperative exams were unable to solve the diagnostic query, and the diagnosis was achieved only at laparotomy. One-stage combined enterolithotomy and cholecystectomy were performed.


The two patients had an uneventful recovery. To our knowledge, this is the first report of gallstone ileus after biliointestinal bypass.

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