Laparoscopic and ultrasound assisted management of gallstone ileus after biliointestinal bypass Case report and a review of literature.

AIM To report about an additional case of biliary ileus after bariatric surgery is reported and extensively reviewing the literature on this topic. MATERIAL OF STUDY We reviewed the literature and found three cases of gallstone ileus (GI) that occurred after bariatric surgery. DISCUSSION A 41 year old patient presented a GI eight years after a biliointestinal bypass (BIB) for morbid obesity. The patient complained of abdominal pain for two weeks. Computed tomography (CT) and abdominal ultrasound (US) allowed a preoperative diagnosis of GI and planning of surgical strategy. Surgical treatment was carried out through laparoscopic-assisted enterolithotomy alone procedure. This choice is supported discussing the related issues: morbidity, potential recurrence, eventual developing of gallbladder carcinoma. CONCLUSION It is the first reported case of GI after BIB preoperatively diagnosed through CT scan and US, and treated with a laparoscopic assisted approach. Additional considerations concerning preoperative diagnosis, surgical strategy, technical details and follow-up can be usefully applied even in non post-bariatric biliary ileus. KEY WORDS Biliointestinal bypass, Gallstone ileus, Laparoscopy, Ultrasonography.