Biliopancreatic Limb Obstruction Secondary to 9 cm Gallstone Nearly Two Decades Following Open Roux-en-Y Gastric Bypass and Cholecystectomy: A Rare and Challenging Case

Division

South Atlantic

Hospital

Orange Park Medical Center

Document Type

Case Report

Publication Date

12-4-2025

Keywords

Roux-en-Y gastric bypass, biliopancreatic limb obstruction, cholecystectomy, gallstone ileus

Disciplines

Digestive System Diseases | Medicine and Health Sciences | Surgery | Surgical Procedures, Operative

Abstract

Gallstone ileus is a rare complication of chronic cholelithiasis and an exceedingly uncommon cause of bowel obstruction following Roux-en-Y gastric bypass (RYGB), particularly after cholecystectomy. We report the first known case of a large gallstone causing obstruction of the biliopancreatic limb in an 80-year-old woman with prior RYGB, cholecystectomy, and choledochoduodenostomy. She underwent successful open enterolithotomy with stone extraction. This case highlights the diagnostic and technical challenges posed by altered post-RYGB anatomy and emphasizes the importance of maintaining a high index of suspicion in similar presentations. Early recognition and individualized operative management are critical to achieving favorable outcomes in this rare but potentially life-threatening condition.

Publisher or Conference

Journal of Surgical Case Reports

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